1710080171 NPI number — PORTER ADVENTIST HEALTH SYSTEM

Table of content: MRS. CRYSTAL GALE RICKETT RD LD (NPI 1902358633)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710080171 NPI number — PORTER ADVENTIST HEALTH SYSTEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PORTER 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:
Provider Other Organization Name Type Code:
6
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:
1710080171
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1391 SPEER BLVD
Provider Second Line Business Mailing Address:
SUITE 600
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80204-2508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-561-5000
Provider Business Mailing Address Fax Number:
303-561-5050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5020 E ARAPAHOE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLETON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80122-2302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-694-3545
Provider Business Practice Location Address Fax Number:
303-694-5103
Provider Enumeration Date:
09/07/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PITTMAN
Authorized Official First Name:
JEREMY
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
303-643-1235

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  0696 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 05800198 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".