=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154680221
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PORTERCARE ADVENTIST HEALTH SYSTEM
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2012
-----------------------------------------------------
Last Update Date | 05/10/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7750 S BROADWAY SUITE 220
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80122-2623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-528-0860
-----------------------------------------------------
Fax | 720-528-0861
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 911244
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80291-1244
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-486-5401
-----------------------------------------------------
Fax | 303-486-5502
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP-FINANCE CHPG
-----------------------------------------------------
Name | DAVID P HESSELINK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 303-804-8136
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RR0500X
-----------------------------------------------------
Taxonomy Name | Rheumatology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------