Provider Demographics
NPI:1841458601
Name:ALPINE WOMENS CENTER PC
Entity type:Organization
Organization Name:ALPINE WOMENS CENTER PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:BEACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-862-6436
Mailing Address - Street 1:2002 HOSPITAL WAY
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937
Mailing Address - Country:US
Mailing Address - Phone:406-862-6436
Mailing Address - Fax:406-862-9978
Practice Address - Street 1:2002 HOSPITAL WAY
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937
Practice Address - Country:US
Practice Address - Phone:406-862-6436
Practice Address - Fax:406-862-9978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMT8350207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT16011OtherBCBS
MT0021318Medicaid
27D0965078OtherCLIA
010001601Medicare PIN
MT0021318Medicaid