1558970079 NPI number — PORTERCARE ADVENTIST HEALTH SYSTEM

Table of content: THEA ELIZABETH BREGMAN M.D. (NPI 1255645032)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558970079 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:
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:
1558970079
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 713425
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60677-4325
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2360 MEADOWS BLVD
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
CASTLE ROCK
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80109-8034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-455-3775
Provider Business Practice Location Address Fax Number:
720-455-3776
Provider Enumeration Date:
07/30/2020

Additional Information

Authorized Official

Authorized Official Last Name:
TACHA
Authorized Official First Name:
JASON
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
303-304-7752

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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