MEDICARE: PORTERCARE ADVENTIST HEALTH SYSTEMS

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	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215268974
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PORTERCARE ADVENTIST HEALTH SYSTEMS

Provider Business Mailing Address
First Line	:	PO BOX 911244
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80291-1244
Country	:	US
Telephone Number	:	303-643-1099
Fax Number	:	303-643-1176

Provider Business Practice Location Address
First Line	:	611 MITCHELL WAY
Second Line	:	SUITE 103
City	:	ERIE
State	:	CO
Zip	:	80516-5441
Country	:	US
Telephone Number	:	303-269-2780
Fax Number	:	303-269-2790

Authorized Official
Title or Position	:	OMA ADMINISTRATOR
Name	:	ANGELA SKINNER
Credential	:
Telephone Number	:	303-673-7175

Provider Enumeration Date	:	01/20/2010
Last Update Date	:	04/20/2016

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