Provider Demographics
NPI:1548345069
Name:ALPINE ALLERGY AND ASTHMA ASSOCIATES INC.
Entity type:Organization
Organization Name:ALPINE ALLERGY AND ASTHMA ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JUDE
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-273-6530
Mailing Address - Street 1:300 SIERRA COLLEGE DR
Mailing Address - Street 2:STE 235
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5082
Mailing Address - Country:US
Mailing Address - Phone:530-273-6530
Mailing Address - Fax:530-273-3951
Practice Address - Street 1:300 SIERRA COLLEGE DR
Practice Address - Street 2:STE 235
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5082
Practice Address - Country:US
Practice Address - Phone:530-273-6530
Practice Address - Fax:530-273-3951
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALPINE ALLERGY AND ASTHMA ASSOCIATES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-25
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0100571Medicaid
CAZZZ64412ZOtherBLUE SHIELD
CAGR0100571Medicaid