MEDICARE: ALPINE MEDICAL SUPPLY, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659359933
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPINE MEDICAL SUPPLY, INC

Provider Business Mailing Address
First Line	:	1602 BRENDA DR
Second Line	:
City	:	PLOVER
State	:	WI
Zip	:	54467-2315
Country	:	US
Telephone Number	:	715-345-1771
Fax Number	:	715-345-0359

Provider Business Practice Location Address
First Line	:	2536 PLOVER RD
Second Line	:	SUITE 1
City	:	PLOVER
State	:	WI
Zip	:	54467-3913
Country	:	US
Telephone Number	:	715-345-1771
Fax Number	:	715-345-0359

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. GARY L. FENN
Credential	:
Telephone Number	:	715-345-1771

Provider Enumeration Date	:	01/05/2006
Last Update Date	:	12/04/2007

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