MEDICARE: ALPINE PROSTHETICS AND ORTHOTICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier	CP823	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346245206
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPINE PROSTHETICS AND ORTHOTICS

Provider Business Mailing Address
First Line	:	902 S 4TH ST
Second Line	:
City	:	MONTROSE
State	:	CO
Zip	:	81401-4226
Country	:	US
Telephone Number	:	970-252-1956
Fax Number	:	970-252-1936

Provider Business Practice Location Address
First Line	:	902 S 4TH ST
Second Line	:
City	:	MONTROSE
State	:	CO
Zip	:	81401-4226
Country	:	US
Telephone Number	:	970-252-1956
Fax Number	:	970-252-1936

Authorized Official
Title or Position	:	CERTIFIED PROSTHETIST/MANAGER
Name	:	MR. THOMAS J WATSON
Credential	:	CP
Telephone Number	:	970-252-1956

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	09/18/2008

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