Healthcare Provider Details

I. General information

NPI: 1801879226
Provider Name (Legal Business Name): ALPINE MANAGEMENT AND CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 10/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 MEDICAL DR STE A
BRIGHAM CITY UT
84302-3276
US

IV. Provider business mailing address

2310 N 400 E SUITE A
LOGAN UT
84341-1788
US

V. Phone/Fax

Practice location:
  • Phone: 435-723-9700
  • Fax: 435-787-1913
Mailing address:
  • Phone: 435-787-2000
  • Fax: 435-787-1913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number
License Number StateUT
# 5
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5336197-0501
License Number StateUT

VIII. Authorized Official

Name: SPENCER BOWEN HENINGER
Title or Position: PODIATRIST
Credential: DPM
Phone: 435-787-2000