Healthcare Provider Details

I. General information

NPI: 1588113716
Provider Name (Legal Business Name): ALPINE SURGICAL ASSISTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2016
Last Update Date: 09/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3475 BRIARGATE BLVD SUITE 200
COLORADO SPRINGS CO
80920-4170
US

IV. Provider business mailing address

3475 BRIARGATE BLVD SUITE 200
COLORADO SPRINGS CO
80920-4170
US

V. Phone/Fax

Practice location:
  • Phone: 719-219-2400
  • Fax: 719-219-2409
Mailing address:
  • Phone: 719-219-2400
  • Fax: 719-219-2409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number StateCO

VIII. Authorized Official

Name: TIMOTHY DEONIER
Title or Position: AUTHORIZED OFFICIAL / MANAGER
Credential: SA
Phone: 210-387-7193