Provider Demographics
NPI:1063225332
Name:ALTA MEDGEN LLC
Entity type:Organization
Organization Name:ALTA MEDGEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATALJA
Authorized Official - Middle Name:
Authorized Official - Last Name:BACKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-662-5044
Mailing Address - Street 1:12201 PECOS ST STE 200
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-3920
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12201 PECOS ST STE 200
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80234-3920
Practice Address - Country:US
Practice Address - Phone:954-662-5044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory