Provider Demographics
NPI:1871928788
Name:ALPINE FACIAL SURGERY
Entity type:Organization
Organization Name:ALPINE FACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:LUPORI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-871-0900
Mailing Address - Street 1:940 CENTRAL PARK DR
Mailing Address - Street 2:SUITE #106
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487-8816
Mailing Address - Country:US
Mailing Address - Phone:970-871-0900
Mailing Address - Fax:970-871-0662
Practice Address - Street 1:940 CENTRAL PARK DR
Practice Address - Street 2:SUITE #106
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-8816
Practice Address - Country:US
Practice Address - Phone:970-871-0900
Practice Address - Fax:970-871-0662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical