Healthcare Provider Details

I. General information

NPI: 1700153574
Provider Name (Legal Business Name): ALPINE CLINICAL RESEARCH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2011
Last Update Date: 11/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 ALPINE AVE SUITE 200
BOULDER CO
80304-3406
US

IV. Provider business mailing address

1000 ALPINE AVE SUITE 200
BOULDER CO
80304-3406
US

V. Phone/Fax

Practice location:
  • Phone: 303-443-7229
  • Fax: 303-443-7748
Mailing address:
  • Phone: 303-443-7229
  • Fax: 303-443-7748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number30904
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MARGARET SHARP
Title or Position: PRESIDENT
Credential: RN
Phone: 303-443-7229