Healthcare Provider Details

I. General information

NPI: 1265791321
Provider Name (Legal Business Name): PORTERCARE ADVENTIST HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2012
Last Update Date: 05/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9397 CROWN CREST BLVD SUITE 220A
PARKER CO
80138-8575
US

IV. Provider business mailing address

PO BOX 911244
DENVER CO
80291-1244
US

V. Phone/Fax

Practice location:
  • Phone: 303-721-8117
  • Fax: 720-842-5140
Mailing address:
  • Phone: 303-486-5401
  • Fax: 303-486-5502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

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