Provider Demographics
NPI:1891020566
Name:ALPINE ANESTHESIA ASSOCIATES LLC
Entity Type:Organization
Organization Name:ALPINE ANESTHESIA ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:T
Authorized Official - Last Name:MOUNTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-575-2225
Mailing Address - Street 1:PO BOX 864613
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-4613
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:777 DELTONA BLVD
Practice Address - Street 2:STE 21
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-7173
Practice Address - Country:US
Practice Address - Phone:386-575-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-13
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty