Healthcare Provider Details

I. General information

NPI: 1518348580
Provider Name (Legal Business Name): PORTERCARE ADVENTIST HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 06/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 S BROADWAY ST SUITE 103
BOULDER CO
80305-5971
US

IV. Provider business mailing address

PO BOX 911244
DENVER CO
80291-1244
US

V. Phone/Fax

Practice location:
  • Phone: 303-649-3240
  • Fax: 720-582-9903
Mailing address:
  • Phone: 303-643-1040
  • Fax: 303-643-1176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ANGELA SKINNER
Title or Position: OMA / ADMINISTRATOR
Credential:
Phone: 303-643-0925