1790720464 NPI number — ALPINE EAR, NOSE AND THROAT PLLC

Table of content: (NPI 1790720464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790720464 NPI number — ALPINE EAR, NOSE AND THROAT PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALPINE EAR, NOSE AND THROAT PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ALL ABOUT HEARING
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790720464
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1120 E ELIZABETH ST
Provider Second Line Business Mailing Address:
F-101
Provider Business Mailing Address City Name:
FORT COLLINS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80524-4044
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-221-1177
Provider Business Mailing Address Fax Number:
970-484-5990

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1120 E ELIZABETH ST
Provider Second Line Business Practice Location Address:
F-101
Provider Business Practice Location Address City Name:
FORT COLLINS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80524-4044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-221-1177
Provider Business Practice Location Address Fax Number:
970-484-5990
Provider Enumeration Date:
06/18/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MOONEY-MALONE
Authorized Official First Name:
LORI
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
970-584-1063

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207YX0905X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 04005625 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".