Provider Demographics
NPI:1992308191
Name:ALPINE ORTHOPAEDICS & SPORTS MEDICINE PC
Entity type:Organization
Organization Name:ALPINE ORTHOPAEDICS & SPORTS MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-641-6788
Mailing Address - Street 1:112 W SPENCER AVE STE A
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-2546
Mailing Address - Country:US
Mailing Address - Phone:970-641-6788
Mailing Address - Fax:970-641-0282
Practice Address - Street 1:405 ELK AVE
Practice Address - Street 2:
Practice Address - City:CRESTED BUTTE
Practice Address - State:CO
Practice Address - Zip Code:81224
Practice Address - Country:US
Practice Address - Phone:970-641-6788
Practice Address - Fax:970-349-1049
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALPINE ORTHOPAEDICS & SPORTS MEDICINE PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO76232735Medicaid