Healthcare Provider Details

I. General information

NPI: 1083626832
Provider Name (Legal Business Name): ALPINE ORTHOPEDICS & SPORTS MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

536 COTTONWOOD RD SUITE 100
BOZEMAN MT
59718
US

IV. Provider business mailing address

536 COTTONWOOD RD SUITE 100
BOZEMAN MT
59718
US

V. Phone/Fax

Practice location:
  • Phone: 406-586-8029
  • Fax: 406-586-8009
Mailing address:
  • Phone: 406-586-8029
  • Fax: 406-586-8009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number8221
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK C DEIBERT
Title or Position: PRESIDENT
Credential: MD
Phone: 406-586-8029