Organization Name: | ALPINE FAMILY MEDICINE PC |
NPI Number: | 1861523649 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DEREK GEDLAMAN (CEO) |
Mailing Address: | 734 9th St W Suite 12 Columbia Falls |
State: | MT US |
Postal Code: | 599123859 |
Phone Number: | 4068921011 |
Fax Number: | 4068922108 |
NPI Enumeration Date: | 03/07/2007 |
NPI Last Update Date: | 08/26/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 312 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MT |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |