Basic Information
Provider Information | |||||||||
NPI: | 1366851578 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | THE ALPINE CLINIC, PLLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 580 SAINT JOHNSBURY RD | ||||||||
Address2: | SUITE 13 | ||||||||
City: | LITTLETON | ||||||||
State: | NH | ||||||||
PostalCode: | 035613437 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6032597700 | ||||||||
FaxNumber: | 6032597679 | ||||||||
Practice Location | |||||||||
Address1: | 580 SAINT JOHNSBURY RD | ||||||||
Address2: | SUITE 13 | ||||||||
City: | LITTLETON | ||||||||
State: | NH | ||||||||
PostalCode: | 035613437 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6032597700 | ||||||||
FaxNumber: | 6032597679 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/13/2014 | ||||||||
LastUpdateDate: | 06/14/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MACARTHUR | ||||||||
AuthorizedOfficialFirstName: | DOUGALD | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
AuthorizedOfficialTelephone: | 6038238600 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | D.O. | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | NH11511 | NH | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |   |
No ID Information.