Provider Demographics
NPI:1699922005
Name:ALPINE RADIATION ONCOLOGY SERVICES, PLLC
Entity type:Organization
Organization Name:ALPINE RADIATION ONCOLOGY SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:K
Authorized Official - Last Name:MCNEELY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-926-9800
Mailing Address - Street 1:120 OLD LARAMIE TRL E
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-7012
Mailing Address - Country:US
Mailing Address - Phone:303-926-9800
Mailing Address - Fax:303-926-9801
Practice Address - Street 1:120 OLD LARAMIE TRL E
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-7012
Practice Address - Country:US
Practice Address - Phone:303-926-9800
Practice Address - Fax:303-926-9801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-27
Last Update Date:2011-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO29699261QX0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOA103531OtherINDIVIDUAL PTAN
COCOA103530OtherGROUP PTAN
COCOB4389Medicare UPIN