Healthcare Provider Details

I. General information

NPI: 1588162283
Provider Name (Legal Business Name): ALPINE MANAGEMENT AND CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2018
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 N 400 E STE A
LOGAN UT
84341-1796
US

IV. Provider business mailing address

2310 N 400 E STE A
LOGAN UT
84341-1796
US

V. Phone/Fax

Practice location:
  • Phone: 435-787-2000
  • 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 Number336606-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number9417126-1205
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5336197-0501
License Number StateUT

VIII. Authorized Official

Name: SUSAN MARIE TAYLOR
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 801-505-0821