Organization Name: | ALPINE MEDICAL GROUP OF THE ROARING FORK VALLEY |
NPI Number: | 1356494249 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | STEPHANIE CHILDREE (PRACTICE MANAGER) |
Mailing Address: | 1450 E Valley Rd Suite 101 Basalt |
State: | CO US |
Postal Code: | 816218304 |
Phone Number: | 9709276101 |
Fax Number: | 9709276888 |
NPI Enumeration Date: | 01/22/2007 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |