Provider Demographics
NPI:1053142646
Name:ALPINE MEDICAL GROUP COLORADO PLLC
Entity type:Organization
Organization Name:ALPINE MEDICAL GROUP COLORADO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-728-5170
Mailing Address - Street 1:999 17TH ST STE 500
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-2728
Mailing Address - Country:US
Mailing Address - Phone:720-728-5170
Mailing Address - Fax:720-866-9967
Practice Address - Street 1:3655 E 104TH AVE UNIT A
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-6136
Practice Address - Country:US
Practice Address - Phone:303-254-8500
Practice Address - Fax:303-453-4994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty