Healthcare Provider Details

I. General information

NPI: 1831421429
Provider Name (Legal Business Name): ALPINE CENTER MEDICAL SERVICES LC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2010
Last Update Date: 02/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5689 S REDWOOD RD SUITE 30
SALT LAKE CITY UT
84123-5447
US

IV. Provider business mailing address

5689 S REDWOOD RD SUITE 30
SALT LAKE CITY UT
84123-5447
US

V. Phone/Fax

Practice location:
  • Phone: 801-268-1715
  • Fax: 801-268-1783
Mailing address:
  • Phone: 801-268-1715
  • Fax: 801-268-1783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: HEATHER MICHELLE CHILD
Title or Position: ADMINISTRATOR
Credential:
Phone: 801-268-1715