Healthcare Provider Details

I. General information

NPI: 1407126071
Provider Name (Legal Business Name): PORTERCARE ADVENTIST HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2012
Last Update Date: 01/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HEALTH PARK DR
LOUISVILLE CO
80027-9583
US

IV. Provider business mailing address

DEPT 1244
DENVER CO
80291-1244
US

V. Phone/Fax

Practice location:
  • Phone: 303-673-1000
  • Fax:
Mailing address:
  • Phone: 303-486-5401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: RANDY BUCHNOWSKI
Title or Position: COO
Credential:
Phone: 303-804-8111