Healthcare Provider Details

I. General information

NPI: 1720541634
Provider Name (Legal Business Name): PORTERCARE ADVENTIST HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2019
Last Update Date: 04/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19641 E PARKER SQUARE DR STE A
PARKER CO
80134-7397
US

IV. Provider business mailing address

PO BOX 911244
DENVER CO
80291-1244
US

V. Phone/Fax

Practice location:
  • Phone: 303-840-3800
  • Fax: 303-840-8442
Mailing address:
  • Phone: 800-953-0104
  • Fax: 303-765-6640

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 Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ANGELA SKINNER
Title or Position: DIRECTOR OFFICE OF MEDICAL AFFAIRS
Credential:
Phone: 303-673-7175