Provider Demographics
NPI:1669037115
Name:ALPINE MEDICAL
Entity Type:Organization
Organization Name:ALPINE MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-899-3733
Mailing Address - Street 1:3100 BIG HORN AVE
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-8564
Mailing Address - Country:US
Mailing Address - Phone:307-587-5001
Mailing Address - Fax:307-586-4221
Practice Address - Street 1:145 S BENT ST
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-2713
Practice Address - Country:US
Practice Address - Phone:307-764-3620
Practice Address - Fax:307-764-3621
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALPINE MEDICAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-09
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY0151904200Medicaid