Provider Demographics
NPI:1619736725
Name:PORTERCARE ADVENTIST HEALTH SYSTEM
Entity Type:Organization
Organization Name:PORTERCARE ADVENTIST HEALTH SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:TACHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-304-7752
Mailing Address - Street 1:2356 MEADOWS BLVD STE 240B
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-8410
Mailing Address - Country:US
Mailing Address - Phone:303-649-3575
Mailing Address - Fax:720-993-4023
Practice Address - Street 1:2356 MEADOWS BLVD STE 240B
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-8410
Practice Address - Country:US
Practice Address - Phone:303-649-3575
Practice Address - Fax:720-993-4023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive SurgeryGroup - Multi-Specialty