Provider Demographics
NPI:1831421429
Name:ALPINE CENTER MEDICAL SERVICES LC
Entity type:Organization
Organization Name:ALPINE CENTER MEDICAL SERVICES LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:CHILD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-268-1715
Mailing Address - Street 1:5689 S REDWOOD RD
Mailing Address - Street 2:SUITE 30
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-5447
Mailing Address - Country:US
Mailing Address - Phone:801-268-1715
Mailing Address - Fax:801-268-1783
Practice Address - Street 1:5689 S REDWOOD RD
Practice Address - Street 2:SUITE 30
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84123-5447
Practice Address - Country:US
Practice Address - Phone:801-268-1715
Practice Address - Fax:801-268-1783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty