Healthcare Provider Details

I. General information

NPI: 1013121003
Provider Name (Legal Business Name): ALPINE PLASTIC AND RECONSTRUCTIVE SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5405 S 500 E SUITE101
OGDEN UT
84405-6957
US

IV. Provider business mailing address

5405 S 500 E SUITE101
OGDEN UT
84405-6957
US

V. Phone/Fax

Practice location:
  • Phone: 801-689-3500
  • Fax: 801-689-3505
Mailing address:
  • Phone: 801-689-3500
  • Fax: 801-689-3505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MS. CAROLE T GROBE
Title or Position: BILLING BUSINESS MANAGER
Credential: CCS-P, CPC
Phone: 801-689-3506