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General NPI Number Information
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NPI Number | 1649278581
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Entity Type | Organization
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Legal Business Name | ALPINE SURGICAL CENTER, LLC
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Dates
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Enumeration Date | 07/13/2005
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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 | MEDICAL DIRECTOR
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Name | RANDALL D. BARNETT
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Credential | MD
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Telephone | 801-689-3500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 46C001031
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License Number State | UT
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