Provider Demographics
NPI:1972109817
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:AO
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:801-590-2714
Mailing Address - Fax:801-463-2880
Practice Address - Street 1:132 E 13065 S STE 100
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-8634
Practice Address - Country:US
Practice Address - Phone:801-590-2714
Practice Address - Fax:801-463-2880
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALPINE HOME MEDICAL EQUIPMENT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies