# ALPINE ORTHOPAEDIC MEDICAL GROUP INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114005352
- **Authorized official:** MRS. ANNE DUNN MCCUNE MS HSA (PRACTICE ADMINISTRATION)
- **Authorized official phone:** (209) 946-7139

## Contact information

- **Practice address:** 2488 N. CALIFORNIA ST, STOCKTON, CA 95204-5508
- **Practice address phone:** (209) 948-3333
- **Practice address fax:** (209) 948-3330
- **Mailing address:** 2488 N. CALIFORNIA ST, STOCKTON, CA 95204-5508
- **Mailing address phone:** (209) 948-3333
- **Mailing address fax:** (209) 948-3330

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |
| 207XP3100X | Pediatric Orthopaedic Surgery Physician | — | NULL | — |
| 207XP3100X | Pediatric Orthopaedic Surgery Physician | — | — | — |
| 207XS0106X | Orthopaedic Hand Surgery Physician | — | NULL | — |
| 207XS0106X | Orthopaedic Hand Surgery Physician | — | — | — |
| 207XS0114X | Adult Reconstructive Orthopaedic Surgery Physician | — | NULL | — |
| 207XS0114X | Adult Reconstructive Orthopaedic Surgery Physician | — | — | — |
| 207XS0117X | Orthopaedic Surgery of the Spine Physician | — | NULL | — |
| 207XS0117X | Orthopaedic Surgery of the Spine Physician | — | — | — |
| 207XX0004X | Orthopaedic Foot and Ankle Surgery Physician | — | NULL | — |
| 207XX0004X | Orthopaedic Foot and Ankle Surgery Physician | — | — | — |
| 207XX0005X | Sports Medicine (Orthopaedic Surgery) Physician | — | NULL | — |
| 207XX0005X | Sports Medicine (Orthopaedic Surgery) Physician | — | — | — |
| 207XX0801X | Orthopaedic Trauma Physician | — | NULL | — |
| 207XX0801X | Orthopaedic Trauma Physician | — | — | — |

## Other

- **Enumeration date:** 11/02/2006
- **Last updated:** 01/18/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0368640001 | DMERC SUPPLIER NUMBER | CA |
| 01 | — | 195690700 | USDL | — |
| 01 | — | CGP159090 | CGP \# | — |
| 05 | — | ZZZ71793Z | — | CA |