Provider Demographics
NPI:1710730106
Name:ALPINE SUN FAMILY MEDICINE
Entity Type:Organization
Organization Name:ALPINE SUN FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHANSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:720-284-2814
Mailing Address - Street 1:PO BOX 1213
Mailing Address - Street 2:
Mailing Address - City:TABERNASH
Mailing Address - State:CO
Mailing Address - Zip Code:80478-0207
Mailing Address - Country:US
Mailing Address - Phone:720-284-2814
Mailing Address - Fax:
Practice Address - Street 1:78878 US HIGHWAY 40
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:CO
Practice Address - Zip Code:80482-5194
Practice Address - Country:US
Practice Address - Phone:720-284-2814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care