Provider Demographics
NPI:1588851091
Name:ALPINE MEDICAL SUPPLY & REHAB
Entity Type:Organization
Organization Name:ALPINE MEDICAL SUPPLY & REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WHITENIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-258-8200
Mailing Address - Street 1:PO BOX 478
Mailing Address - Street 2:
Mailing Address - City:KALKASKA
Mailing Address - State:MI
Mailing Address - Zip Code:49646-0478
Mailing Address - Country:US
Mailing Address - Phone:231-258-8200
Mailing Address - Fax:231-258-8204
Practice Address - Street 1:333 MAGAZINE ST
Practice Address - Street 2:STE 103
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-1867
Practice Address - Country:US
Practice Address - Phone:906-632-4400
Practice Address - Fax:231-258-8204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4699720Medicaid
MI510A710580OtherBLUE CROSS BLUE SHIELD
MI4897790002Medicare NSC