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NPI Code Detail

MEDICARE: PORTERCARE ADVENTIST HEALTH SYSTEM

MEDICARE: PORTERCARE ADVENTIST HEALTH SYSTEM
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
1207T00000XNeurological Surgery Physician

General Provider Information

NPI Number : 1427881598
Entity Type Code : Organization
Provider Name (Legal Business Name) : PORTERCARE ADVENTIST HEALTH SYSTEM
Provider Business Mailing Address
First Line : PO BOX 713425
Second Line :
City : CHICAGO
State : IL
Zip : 60677-4325
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 12596 W BAYAUD AVE STE 100
Second Line :
City : LAKEWOOD
State : CO
Zip : 80228-2035
Country : US
Telephone Number : 720-638-7500
Fax Number : 720-583-6770
Authorized Official
Title or Position : COO
Name : MR. JASON TACHA
Credential :
Telephone Number : 303-304-7752
Provider Enumeration Date : 08/23/2024
Last Update Date : 08/23/2024

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1962243444 — NICOLE TUCKER PA-C
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Directions to “PORTERCARE ADVENTIST HEALTH SYSTEM ” Practice Location

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