MEDICARE: SOUTHPORT HEALTHCARE INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1063233229
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHPORT HEALTHCARE INC.

Provider Business Mailing Address
First Line	:	1001 BANNOCK ST UNIT 227
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80204-4145
Country	:	US
Telephone Number	:	720-902-7069
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 BANNOCK ST UNIT 227
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80204-4145
Country	:	US
Telephone Number	:	720-902-7069
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. ELIZABETH ODWYER
Credential	:	RN
Telephone Number	:	303-503-3616

Provider Enumeration Date	:	10/21/2024
Last Update Date	:	10/21/2024

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Directions to “SOUTHPORT HEALTHCARE INC. ” Practice Location

Language	Start Address	Practice Location

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