Healthcare Provider Details

I. General information

NPI: 1265341291
Provider Name (Legal Business Name): ADVENTHEALTH PRIMARY CARE RMR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 S ELIZABETH ST UNIT 103
ELIZABETH CO
80107-7546
US

IV. Provider business mailing address

2600 WESTHALL LN STE 200
MAITLAND FL
32751-7107
US

V. Phone/Fax

Practice location:
  • Phone: 303-269-2551
  • Fax: 303-269-2552
Mailing address:
  • Phone: 407-200-2857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DESTIN HARCUS
Title or Position: CFO
Credential:
Phone: 225-328-1607