Healthcare Provider Details

I. General information

NPI: 1225212731
Provider Name (Legal Business Name): PORTERCARE ADVENTIST HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2007
Last Update Date: 12/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 INVERNESS DR WEST SUITE 500
ENGLEWOOD CO
80112-5205
US

IV. Provider business mailing address

188 INVERNESS DR WEST SUITE 500
ENGLEWOOD CO
80112-5205
US

V. Phone/Fax

Practice location:
  • Phone: 303-290-6500
  • Fax:
Mailing address:
  • Phone: 303-290-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES BOYLE
Title or Position: CEO
Credential:
Phone: 303-778-5294