Healthcare Provider Details

I. General information

NPI: 1871928788
Provider Name (Legal Business Name): ALPINE FACIAL SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2013
Last Update Date: 09/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 CENTRAL PARK DR SUITE #106
STEAMBOAT SPRINGS CO
80487-8816
US

IV. Provider business mailing address

940 CENTRAL PARK DR SUITE #106
STEAMBOAT SPRINGS CO
80487-8816
US

V. Phone/Fax

Practice location:
  • Phone: 970-871-0900
  • Fax: 970-871-0662
Mailing address:
  • Phone: 970-871-0900
  • Fax: 970-871-0662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateCO

VIII. Authorized Official

Name: JOHN PAUL LUPORI
Title or Position: OWNER
Credential: M.D.
Phone: 970-871-0900