Provider Demographics
NPI:1366527889
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:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:LACEY
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-888-1016
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 1:3254 PROFESSIONAL DRIVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-2412
Practice Address - Country:US
Practice Address - Phone:530-888-1016
Practice Address - Fax:530-888-1346
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
207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0100570Medicaid
CAZZZ64413OtherBLUE SHIELD
CAZZZ64413OtherBLUE SHIELD