Healthcare Provider Details

I. General information

NPI: 1346535176
Provider Name (Legal Business Name): PORTERCARE ADVENTIST HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2011
Last Update Date: 05/16/2021
Certification Date: 05/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9403 CROWN CREST BLVD STE 200INTEG
PARKER CO
80138-8882
US

IV. Provider business mailing address

PO BOX 801106
KANSAS CITY MO
64180-1106
US

V. Phone/Fax

Practice location:
  • Phone: 303-721-1670
  • Fax: 303-721-8117
Mailing address:
  • Phone: 800-953-0104
  • Fax: 303-765-6670

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: ANGELA J SKINNER
Title or Position: OMA ADMINISTRATOR
Credential:
Phone: 303-673-7175