Provider Demographics
NPI:1740400290
Name:AVISTA ADVENTIST HOSPITAL
Entity Type:Organization
Organization Name:AVISTA ADVENTIST HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEONATAL NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:SANDER
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:NNP, MHA
Authorized Official - Phone:303-673-1102
Mailing Address - Street 1:2855 ROCK CREEK CIR UNIT 254
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:CO
Mailing Address - Zip Code:80027-4621
Mailing Address - Country:US
Mailing Address - Phone:303-494-4354
Mailing Address - Fax:
Practice Address - Street 1:100 HEALTH PARK DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-9583
Practice Address - Country:US
Practice Address - Phone:303-673-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO90831282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital