Provider Demographics
NPI:1851499792
Name:ALPINE DIAGNOSTIC IMAGING, PA
Entity Type:Organization
Organization Name:ALPINE DIAGNOSTIC IMAGING, PA
Other - Org Name:ALPINE DIAGNOSTIC IMAGING, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MOELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-837-0207
Mailing Address - Street 1:2600 N HIGHWAY 118
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:TX
Mailing Address - Zip Code:79830-2002
Mailing Address - Country:US
Mailing Address - Phone:432-837-0207
Mailing Address - Fax:432-837-0275
Practice Address - Street 1:2600 N HIGHWAY 118
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:TX
Practice Address - Zip Code:79830-2002
Practice Address - Country:US
Practice Address - Phone:432-837-0207
Practice Address - Fax:432-837-0275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK91322085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1633992-01Medicaid
TX8B0690OtherBC/BS PROVIDER #
TX00124WMedicare ID - Type Unspecified