Healthcare Provider Details

I. General information

NPI: 1366073090
Provider Name (Legal Business Name): PORTERCARE ADVENTIST HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2020
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9949 S OSWEGO ST
PARKER CO
80134-3753
US

IV. Provider business mailing address

PO BOX 801106
KANSAS CITY MO
64180-1106
US

V. Phone/Fax

Practice location:
  • Phone: 303-925-4700
  • Fax: 303-925-4701
Mailing address:
  • Phone: 800-953-0104
  • Fax: 303-765-6670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MATTHEW GAL
Title or Position: CFO
Credential:
Phone: 303-269-4014