Provider Demographics
NPI:1306051032
Name:ALTAMEDIX CORPORATION
Entity type:Organization
Organization Name:ALTAMEDIX CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MIRON
Authorized Official - Middle Name:
Authorized Official - Last Name:BALYASNY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-648-3999
Mailing Address - Street 1:4234 N FREEWAY BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1237
Mailing Address - Country:US
Mailing Address - Phone:916-648-3999
Mailing Address - Fax:916-648-1919
Practice Address - Street 1:4234 N FREEWAY BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-1237
Practice Address - Country:US
Practice Address - Phone:916-648-3999
Practice Address - Fax:916-648-1919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAADU70231FMedicaid