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General NPI Number Information
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NPI Number | 1013121003
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Entity Type | Organization
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Legal Business Name | ALPINE PLASTIC AND RECONSTRUCTIVE SURGERY, LLC
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 05/30/2013
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Provider Practice Location Address
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Address Line | 5405 S 500 E SUITE101
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City | OGDEN
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State | UT
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Zip | 84405-6957
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Country | US
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Telephone | 801-689-3500
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Fax | 801-689-3505
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Provider Business Mailing Address
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Address Line | 5405 S 500 E SUITE101
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City | OGDEN
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State | UT
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Zip | 84405-6957
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Country | US
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Telephone | 801-689-3500
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Fax | 801-689-3505
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Authorized Official
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Title or Position | BILLING BUSINESS MANAGER
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Name | MS. CAROLE T GROBE
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Credential | CCS-P, CPC
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Telephone | 801-689-3506
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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