Basic Information
| Provider Information | |||||||||
| NPI: | 1093124422 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PORTERCARE ADVENTIST HEALTH SYSTEM | ||||||||
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| OtherOrganizationName: | CENTURA HEALTH PHYSICIAN GROUP CHURCH RANCH WOMEN'S HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 911244 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802911244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036431040 | ||||||||
| FaxNumber: | 3036431176 | ||||||||
| Practice Location | |||||||||
| Address1: | 7233 CHURCH RANCH BLVD | ||||||||
| Address2: | |||||||||
| City: | WESTMINSTER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800214094 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039254020 | ||||||||
| FaxNumber: | 3039254021 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2014 | ||||||||
| LastUpdateDate: | 09/25/2015 | ||||||||
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| AuthorizedOfficialLastName: | SKINNER | ||||||||
| AuthorizedOfficialFirstName: | ANGELA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR OMA | ||||||||
| AuthorizedOfficialTelephone: | 3036430925 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.