Healthcare Provider Details

I. General information

NPI: 1790720464
Provider Name (Legal Business Name): ALPINE EAR, NOSE AND THROAT, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 E ELIZABETH ST F-101
FORT COLLINS CO
80524-4044
US

IV. Provider business mailing address

1120 E ELIZABETH ST F-101
FORT COLLINS CO
80524-4044
US

V. Phone/Fax

Practice location:
  • Phone: 970-221-1177
  • Fax: 970-484-5990
Mailing address:
  • Phone: 970-221-1177
  • Fax: 970-484-5990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: LORI MOONEY-MALONE
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 970-584-1063