Healthcare Provider Details

I. General information

NPI: 1801227780
Provider Name (Legal Business Name): ALPINE HOME MEDICAL EQUIPMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2013
Last Update Date: 07/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 S MAIN ST
RICHFIELD UT
84701-2554
US

IV. Provider business mailing address

132 E 13065 S STE 200
DRAPER UT
84020-5646
US

V. Phone/Fax

Practice location:
  • Phone: 435-896-6474
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number6142158-1714
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JAY BROADBENT
Title or Position: OWNER
Credential:
Phone: 801-590-2703