Healthcare Provider Details

I. General information

NPI: 1174132690
Provider Name (Legal Business Name): PORTERCARE ADVENTIST HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2020
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 S DOWNING ST STE 180F
DENVER CO
80210-5847
US

IV. Provider business mailing address

900 HOPE WAY
ALTAMONTE SPRINGS FL
32714-1502
US

V. Phone/Fax

Practice location:
  • Phone: 303-762-0808
  • Fax: 303-762-9292
Mailing address:
  • Phone: 407-357-1874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JASON TACHA
Title or Position: COO
Credential:
Phone: 303-304-7752