Portercare Adventist Health System

Organization Active NPI Surgery Physician · Louisville, CO

NPI 1053920165 · NPPES record last updated Jul 24, 2020

Key facts

NPI
1053920165
Entity type
Organization (NPI type 2)
Primary specialty
Surgery Physician 208600000X
Legal business name
PORTERCARE ADVENTIST HEALTH SYSTEM
Practice address
80 Health Park Dr Ste 270
Louisville, CO 80027-4644
Phone
(303) 925-4030
Fax
(303) 661-1856
NPI assigned
Jul 24, 2020
Organization subpart
No

Authorized official

Name
Mrs. Angela J Skinner
Title
Administrator, Oma
Phone
(303) 673-7175

Corporate family (same tax ID) 19

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in CO

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20090115000327 CO Part B Supplier - Clinic/Group Practice 0941110886 Receives reassigned benefits from 869 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

Tax ID family
Avista Adventist Hospital (210 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician
Group: 193200000X MULTI-SPECIALTY GROUP
208600000X Yes

Addresses

Primary practice location

80 Health Park Dr Ste 270
Louisville, CO 80027-4644

Mailing address

PO Box 801106
Kansas City, MO 64180-1106
Phone (800) 953-0104

Other names

  • BCAV BREASTCARE AVISTA Doing business as
  • Centura Health Physician Group Center for Breast Care PAHS Other name

Other providers in Louisville, CO

All providers in Louisville, CO · Surgery Physician in Colorado

Sources for this page

Verify at the official NPI Registry.