Provider Demographics
NPI:1316031933
Name:ALPINE SPINE CENTER, PC
Entity Type:Organization
Organization Name:ALPINE SPINE CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHLEEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:VAN BUSKIRK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-546-6600
Mailing Address - Street 1:4745 ARAPAHOE AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1080
Mailing Address - Country:US
Mailing Address - Phone:303-546-6600
Mailing Address - Fax:303-546-6500
Practice Address - Street 1:4745 ARAPAHOE AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1080
Practice Address - Country:US
Practice Address - Phone:303-546-6600
Practice Address - Fax:303-546-6500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36624174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C49618OtherMEDICARE PTAN
C496918OtherPTAN
G60701Medicare UPIN