Healthcare Provider Details

I. General information

NPI: 1881600559
Provider Name (Legal Business Name): PORTERCARE ADVENTIST HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 05/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7780 SOUTH BROADWAY SUITE 350
LITTLETON CO
80122
US

IV. Provider business mailing address

P.O. BOX 911244
DENVER CO
80291-1244
US

V. Phone/Fax

Practice location:
  • Phone: 303-734-8650
  • Fax: 303-734-8653
Mailing address:
  • Phone: 303-486-5401
  • Fax: 303-486-5502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number36243
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number36243
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number36243
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code2084P0005X
TaxonomyNeurodevelopmental Disabilities Physician
License Number36243
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number36243
License Number StateCO
# 6
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number36243
License Number StateCO

VIII. Authorized Official

Name: DAVID P HESSELINK
Title or Position: VP-FINANCE PE
Credential:
Phone: 303-804-8136