Provider Demographics
NPI:1306944772
Name:ALPINE EAR, NOSE & THROAT, P.C
Entity type:Organization
Organization Name:ALPINE EAR, NOSE & THROAT, P.C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CAPENER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-524-7244
Mailing Address - Street 1:2065 E 17TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-8042
Mailing Address - Country:US
Mailing Address - Phone:208-524-7244
Mailing Address - Fax:208-524-1088
Practice Address - Street 1:2065 E 17TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-8042
Practice Address - Country:US
Practice Address - Phone:208-524-7244
Practice Address - Fax:208-524-1088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty