Provider Demographics
NPI:1396939203
Name:ALPINE SURGICAL LLC
Entity type:Organization
Organization Name:ALPINE SURGICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-449-3642
Mailing Address - Street 1:4743 ARAPAHOE AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1123
Mailing Address - Country:US
Mailing Address - Phone:303-449-3642
Mailing Address - Fax:
Practice Address - Street 1:4743 ARAPAHOE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1123
Practice Address - Country:US
Practice Address - Phone:303-449-3642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO40751208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALA60580OtherBLUE CROSS BLUE SHIELD
CO29954061Medicaid
CO59501383Medicaid
CO59501383Medicaid