Healthcare Provider Details

I. General information

NPI: 1174488852
Provider Name (Legal Business Name): PORTERCARE ADVENTIST HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12596 W BAYAUD AVE STE 100
LAKEWOOD CO
80228-2035
US

IV. Provider business mailing address

PO BOX 713425
CHICAGO IL
60677-4325
US

V. Phone/Fax

Practice location:
  • Phone: 720-524-1367
  • Fax: 720-524-1422
Mailing address:
  • Phone: 800-953-0104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

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