Provider Demographics
NPI:1518171693
Name:ALPINE MEDICAL CENTER PLLC
Entity Type:Organization
Organization Name:ALPINE MEDICAL CENTER PLLC
Other - Org Name:ALPINE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-837-5505
Mailing Address - Street 1:202 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:TX
Mailing Address - Zip Code:79830-4704
Mailing Address - Country:US
Mailing Address - Phone:432-837-5505
Mailing Address - Fax:432-837-9118
Practice Address - Street 1:202 N 2ND ST
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:TX
Practice Address - Zip Code:79830-4704
Practice Address - Country:US
Practice Address - Phone:432-837-5505
Practice Address - Fax:432-837-9118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1567207Q00000X, 261Q00000X
J1567261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX129492801Medicaid
TX125762OtherSUPERIOR
TX12942807Medicaid
TX111586701Medicaid
TX111586702Medicaid
TX111586703Medicaid
TX125762OtherSUPERIOR
TX111586701Medicaid
TX111586702Medicaid
TX12942807Medicaid