Healthcare Provider Details

I. General information

NPI: 1255841490
Provider Name (Legal Business Name): PORTERCARE ADVENTIST HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2017
Last Update Date: 10/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 E MINERAL CIR FL 2
CENTENNIAL CO
80112-3401
US

IV. Provider business mailing address

PO BOX 911244
DENVER CO
80291-1244
US

V. Phone/Fax

Practice location:
  • Phone: 303-673-8075
  • Fax: 303-649-7156
Mailing address:
  • Phone: 888-269-7001
  • Fax: 303-764-6640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateCO

VIII. Authorized Official

Name: MRS. ANGELA SKINNER
Title or Position: ADMINISTRATOR / OMA
Credential: OMA
Phone: 303-673-7175