Provider Demographics
NPI:1124119714
Name:ALPINE SURGICAL ASSOCIATES PC
Entity type:Organization
Organization Name:ALPINE SURGICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:HERMACINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-879-9299
Mailing Address - Street 1:940 CENTRAL PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487-8853
Mailing Address - Country:US
Mailing Address - Phone:970-879-9299
Mailing Address - Fax:866-228-0896
Practice Address - Street 1:940 CENTRAL PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-8853
Practice Address - Country:US
Practice Address - Phone:972-879-9299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35333208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO91932840Medicaid
COC41141Medicare PIN