Provider Demographics
NPI:1891125084
Name:ALPINE HOME MEDICAL EQUIPMENT LLC
Entity Type:Organization
Organization Name:ALPINE HOME MEDICAL EQUIPMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROADBENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-590-2703
Mailing Address - Street 1:132 E 13065 S STE 200
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-5646
Mailing Address - Country:US
Mailing Address - Phone:801-590-2780
Mailing Address - Fax:
Practice Address - Street 1:1395 N 400 E
Practice Address - Street 2:STE A
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-7530
Practice Address - Country:US
Practice Address - Phone:435-774-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-25
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6142158-1714332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1142610006Medicare NSC