Basic Information
| Provider Information | |||||||||
| NPI: | 1588855258 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE ALPINE CLINIC, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1095 PROFILE ROAD | ||||||||
| Address2: | |||||||||
| City: | FRANCONIA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03580 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038238600 | ||||||||
| FaxNumber: | 6038238688 | ||||||||
| Practice Location | |||||||||
| Address1: | 1095 PROFILE ROAD | ||||||||
| Address2: | |||||||||
| City: | FRANCONIA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03580 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038238600 | ||||||||
| FaxNumber: | 6038238688 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2007 | ||||||||
| LastUpdateDate: | 03/22/2019 | ||||||||
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| AuthorizedOfficialLastName: | CHEN | ||||||||
| AuthorizedOfficialFirstName: | ANDREW | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6038238600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 207X00000X | 12418 | NH | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 30216095 | 05 | NH | MEDICAID |