Alpine Plastic and Reconstructive Surgery, LLC
Organization Active NPI Specialist · Ogden, UT
NPI 1013121003 · NPPES record last updated May 30, 2013
Key facts
- NPI
- 1013121003
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Specialist 174400000X
- Legal business name
- ALPINE PLASTIC AND RECONSTRUCTIVE SURGERY, LLC
- Practice address
- 5405 S 500 E
Suite101
Ogden, UT 84405-6957 - Phone
- (801) 689-3500
- Fax
- (801) 689-3505
- NPI assigned
- May 9, 2007
- Organization subpart
- No
Authorized official
- Name
- Ms. Carole T Grobe, CCS-P, CPC
- Title
- Billing Business Manager
- Phone
- (801) 689-3506
Practitioners 1
-
Randall Dean Barnett, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 46D1042547 | Alpine Plastic & Reconstructive Surgery Center | Certificate of waiver | Jun 30, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050623001053 | UT | Part B Supplier - Clinic/Group Practice | 6305881921 |
Receives reassigned benefits from 1 practitioner Practice locations: Ogden, UT |
National Provider Directory
Locations
1492 W Antelope Dr
#20
Layton, UT 84041
Phone (801) 775-9306
5405 S 500 E
Ste 101
Ogden, UT 84405
Phone (801) 475-5100
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist |
174400000X | Yes |
Addresses
Primary practice location
5405 S 500 E
Suite101
Ogden, UT 84405-6957
Mailing address
5405 S 500 E
Suite101
Ogden, UT 84405-6957
Phone (801) 689-3500
Other providers in Ogden, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 30, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.