Healthcare Provider Details

I. General information

NPI: 1407206725
Provider Name (Legal Business Name): INTERNAL MEDICINE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2016
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8210 SOUTHPARK TER
LITTLETON CO
80120-5614
US

IV. Provider business mailing address

9301 POUNDSTONE PL
GREENWOOD VILLAGE CO
80111-3410
US

V. Phone/Fax

Practice location:
  • Phone: 303-345-8291
  • Fax: 720-914-1010
Mailing address:
  • Phone: 303-345-8291
  • Fax: 720-914-1010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateCO

VIII. Authorized Official

Name: DR. JOSHUA PORTNOY
Title or Position: OWNER
Credential:
Phone: 303-345-8291