Provider Demographics
NPI:1760847008
Name:ALPINE MEDICAL AND SPECIALTY PRACTICE
Entity Type:Organization
Organization Name:ALPINE MEDICAL AND SPECIALTY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TABITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAPPONE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:970-946-9939
Mailing Address - Street 1:30 LIMESTONE CT
Mailing Address - Street 2:
Mailing Address - City:PAGOSA SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81147-8903
Mailing Address - Country:US
Mailing Address - Phone:970-946-9939
Mailing Address - Fax:
Practice Address - Street 1:117 NAVAJO TRAIL DRIVE
Practice Address - Street 2:UNIT Z
Practice Address - City:PAGOSA SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81147-8903
Practice Address - Country:US
Practice Address - Phone:970-946-9939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0990376302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization