Provider Demographics
NPI:1346245206
Name:ALPINE PROSTHETICS AND ORTHOTICS
Entity Type:Organization
Organization Name:ALPINE PROSTHETICS AND ORTHOTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED PROSTHETIST/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:970-252-1956
Mailing Address - Street 1:902 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-4226
Mailing Address - Country:US
Mailing Address - Phone:970-252-1956
Mailing Address - Fax:970-252-1936
Practice Address - Street 1:902 S 4TH ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-4226
Practice Address - Country:US
Practice Address - Phone:970-252-1956
Practice Address - Fax:970-252-1936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCP823335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO75724065Medicaid
CO75724065Medicaid
CO=========OtherANTHEM BC/BS
CO=========OtherROCKY MOUNTAIN HEALTH PLA