1881600559 NPI number — PORTERCARE ADVENTIST HEALTH SYSTEM

Table of content: (NPI 1881600559)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881600559 NPI number — PORTERCARE ADVENTIST HEALTH SYSTEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PORTERCARE ADVENTIST HEALTH SYSTEM
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SOUTH DENVER NEUROSURGERY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881600559
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 911244
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80291-1244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-486-5401
Provider Business Mailing Address Fax Number:
303-486-5502

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7780 SOUTH BROADWAY
Provider Second Line Business Practice Location Address:
SUITE 350
Provider Business Practice Location Address City Name:
LITTLETON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-734-8650
Provider Business Practice Location Address Fax Number:
303-734-8653
Provider Enumeration Date:
08/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HESSELINK
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
P
Authorized Official Title or Position:
VP-FINANCE PE
Authorized Official Telephone Number:
303-804-8136

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X , with the licence number:  36243 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207XS0117X , with the licence number: 36243 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: 36243 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0005X , with the licence number: 36243 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084V0102X , with the licence number: 36243 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085N0700X , with the licence number: 36243 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 73434256 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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