Healthcare Provider Details

I. General information

NPI: 1245993666
Provider Name (Legal Business Name): PORTERCARE ADVENTIST HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2021
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 LAKEVIEW AVE
PUEBLO CO
81004-3508
US

IV. Provider business mailing address

PO BOX 801106
KANSAS CITY MO
64180-1106
US

V. Phone/Fax

Practice location:
  • Phone: 303-778-5797
  • Fax: 303-778-5205
Mailing address:
  • Phone: 800-953-0104
  • Fax: 303-765-6670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANGELA J SKINNER
Title or Position: ADMINISTRATOR, OMA
Credential:
Phone: 303-673-7175