Provider Demographics
NPI:1568792265
Name:ALPINE ANESTHESIA PROFESSIONAL LLC
Entity Type:Organization
Organization Name:ALPINE ANESTHESIA PROFESSIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:J
Authorized Official - Last Name:MONLEZUN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:303-819-1127
Mailing Address - Street 1:1320 ALPINE AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3504
Mailing Address - Country:US
Mailing Address - Phone:303-819-1127
Mailing Address - Fax:303-544-9101
Practice Address - Street 1:1320 ALPINE AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3504
Practice Address - Country:US
Practice Address - Phone:303-819-1127
Practice Address - Fax:303-544-9101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-04
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOB4992Medicare PIN