Provider Demographics
NPI:1316117138
Name:ALPINE FAMILY PRACTICE
Entity type:Organization
Organization Name:ALPINE FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROB
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-544-4667
Mailing Address - Street 1:PO BOX 8930
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-0132
Mailing Address - Country:US
Mailing Address - Phone:623-544-4667
Mailing Address - Fax:623-544-4668
Practice Address - Street 1:14800 W MOUNTAIN VIEW BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-4795
Practice Address - Country:US
Practice Address - Phone:623-544-4667
Practice Address - Fax:623-544-4668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25970207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZH06279Medicare UPIN