Healthcare Provider Details

I. General information

NPI: 1205192325
Provider Name (Legal Business Name): ALPINE KIDNEY & HYPERTENSION INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 MYRTLE AVE STE 204
MURRAY UT
84107-4850
US

IV. Provider business mailing address

154 MYRTLE AVE STE 204
MURRAY UT
84107-4850
US

V. Phone/Fax

Practice location:
  • Phone: 801-288-9002
  • Fax: 801-288-8987
Mailing address:
  • Phone: 801-288-9002
  • Fax: 801-288-8987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number173525-1205
License Number StateUT

VIII. Authorized Official

Name: DR. RICHARD M CLINE
Title or Position: DIRECTOR
Credential: M.D.
Phone: 801-288-9002