Provider Demographics
NPI:1689334419
Name:ANODYNE OF ALPINE LLC
Entity Type:Organization
Organization Name:ANODYNE OF ALPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-829-7772
Mailing Address - Street 1:11020 N 5500 W STE 150
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-9645
Mailing Address - Country:US
Mailing Address - Phone:801-829-7772
Mailing Address - Fax:801-876-5767
Practice Address - Street 1:11020 N 5500 W STE 150
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:UT
Practice Address - Zip Code:84003-9645
Practice Address - Country:US
Practice Address - Phone:801-829-7772
Practice Address - Fax:801-876-5767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty