Alpine Pain & Spinal Rehabilitation Inc

Key facts

NPI

1255844015

Entity type

Organization (NPI type 2)

Primary specialty

Interventional Pain Medicine Physician 208VP0014X

Legal business name

ALPINE PAIN & SPINAL REHABILITATION INC

Practice address

3051 W Maple Loop Dr Ste 125
Lehi, UT 84043-5620

Phone

(801) 766-6055

Fax

(888) 611-8840

NPI assigned

Nov 14, 2017

Organization subpart

No

Authorized official

Name

Brent H Egan, APRN NPI 1376634998

Title

President

Phone

(801) 766-6055

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brent H Egan, NP Nurse Practitioner · Lehi, UT · NPI 1376634998
  Medicare reassignment NPD Authorized official UT

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

Medicare participation

Medicare fee-for-service enrollment

Enrolled in UT

Medicare enrollment records

National Provider Directory

Locations

Specialties & licenses

Addresses

Other identifiers

Other names

• Alpine Pain Solutions of Utah Inc Former legal business name

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 16, 2024.

{
    "created_epoch": "1510617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729036800000",
    "number": "1255844015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3051 W MAPLE LOOP DR STE 125",
            "city": "LEHI",
            "state": "UT",
            "postal_code": "840435620",
            "telephone_number": "801-766-6055",
            "fax_number": "888-611-8840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3051 W MAPLE LOOP DR STE 125",
            "city": "LEHI",
            "state": "UT",
            "postal_code": "840435620",
            "telephone_number": "801-766-6055",
            "fax_number": "888-611-8840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALPINE PAIN & SPINAL REHABILITATION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-14",
        "last_updated": "2024-10-16",
        "certification_date": "2024-10-16",
        "status": "A",
        "authorized_official_last_name": "EGAN",
        "authorized_official_first_name": "BRENT",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "801-766-6055",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1063492304",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Alpine Pain Solutions of Utah Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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All providers in Lehi, UT · Interventional Pain Medicine Physician in Utah