Provider Demographics
NPI:1588113716
Name:ALPINE SURGICAL ASSISTING LLC
Entity type:Organization
Organization Name:ALPINE SURGICAL ASSISTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL / MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEONIER
Authorized Official - Suffix:
Authorized Official - Credentials:SA
Authorized Official - Phone:210-387-7193
Mailing Address - Street 1:3475 BRIARGATE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-4170
Mailing Address - Country:US
Mailing Address - Phone:719-219-2400
Mailing Address - Fax:719-219-2409
Practice Address - Street 1:3475 BRIARGATE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-4170
Practice Address - Country:US
Practice Address - Phone:719-219-2400
Practice Address - Fax:719-219-2409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty