MEDICARE: ALPINE FAMILY MEDICINE PC

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	363AM0700X	Medical Physician Assistant	312	MT
2	207Q00000X	Family Medicine Physician	10336	MT

General Provider Information

NPI Number	:	1861523649
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPINE FAMILY MEDICINE PC

Provider Business Mailing Address
First Line	:	734 9TH ST W
Second Line	:	SUITE 12
City	:	COLUMBIA FALLS
State	:	MT
Zip	:	59912-3859
Country	:	US
Telephone Number	:	406-892-1011
Fax Number	:	406-892-2108

Provider Business Practice Location Address
First Line	:	734 9TH ST W
Second Line	:	SUITE 12
City	:	COLUMBIA FALLS
State	:	MT
Zip	:	59912-3859
Country	:	US
Telephone Number	:	406-892-1011
Fax Number	:	406-892-2108

Authorized Official
Title or Position	:	CEO
Name	:	DEREK GEDLAMAN
Credential	:
Telephone Number	:	406-892-1011

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	08/26/2008

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Directions to “ALPINE FAMILY MEDICINE PC ” Practice Location

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