Provider Demographics
NPI:1649278581
Name:ALPINE SURGICAL CENTER, LLC
Entity type:Organization
Organization Name:ALPINE SURGICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:D
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-689-3500
Mailing Address - Street 1:5405 S 500 E
Mailing Address - Street 2:SUITE101
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-6957
Mailing Address - Country:US
Mailing Address - Phone:801-689-3500
Mailing Address - Fax:801-689-3505
Practice Address - Street 1:5405 S 500 E
Practice Address - Street 2:SUITE101
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-6957
Practice Address - Country:US
Practice Address - Phone:801-689-3500
Practice Address - Fax:801-689-3505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT46C001031261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000100074Medicare PIN