Provider Demographics
NPI:1265652473
Name:ALPINE OPEN IMAGING LLC
Entity Type:Organization
Organization Name:ALPINE OPEN IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:LATHROP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-926-6077
Mailing Address - Street 1:PO BOX 2098
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632-2098
Mailing Address - Country:US
Mailing Address - Phone:970-926-6077
Mailing Address - Fax:866-838-6116
Practice Address - Street 1:BEASLEY CENTER
Practice Address - Street 2:212 CHAMBERS RD
Practice Address - City:EAGLE
Practice Address - State:CO
Practice Address - Zip Code:81632
Practice Address - Country:US
Practice Address - Phone:970-926-6077
Practice Address - Fax:866-838-6116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)