Provider Demographics
NPI:1447644943
Name:ALPINE HOME MEDICAL EQUIPMENT LLC
Entity type:Organization
Organization Name:ALPINE HOME MEDICAL EQUIPMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROADBENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-590-2703
Mailing Address - Street 1:132 E 13065 S
Mailing Address - Street 2:STE 200
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-8618
Mailing Address - Country:US
Mailing Address - Phone:435-590-2703
Mailing Address - Fax:
Practice Address - Street 1:670 S HWY 89
Practice Address - Street 2:STE A
Practice Address - City:KANAB
Practice Address - State:UT
Practice Address - Zip Code:84741-3127
Practice Address - Country:US
Practice Address - Phone:435-644-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-23
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1142610008Medicare NSC