Basic Information
| Provider Information | |||||||||
| NPI: | 1225554801 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALPINE PHYSICIANS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 HAZEL LN STE 305 | ||||||||
| Address2: | |||||||||
| City: | SEWICKLEY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151431249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4125883546 | ||||||||
| FaxNumber: | 4127107068 | ||||||||
| Practice Location | |||||||||
| Address1: | 3660 ROME DR | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 479054488 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7654469394 | ||||||||
| FaxNumber: | 7654478875 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2017 | ||||||||
| LastUpdateDate: | 06/12/2019 | ||||||||
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| AuthorizedOfficialLastName: | BRENNAN | ||||||||
| AuthorizedOfficialFirstName: | COLLEEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP PHYS SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 4125883546 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SYCAMORE SPRINGS, LLC | ||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 300011562 | 05 | IN | MEDICAID |