Provider Demographics
NPI:1780823740
Name:PORTERCARE ADVENTIST HEALTH SYSTEM
Entity Type:Organization
Organization Name:PORTERCARE ADVENTIST HEALTH SYSTEM
Other - Org Name:CHANGE DBA TO: HIGHLANDS RANCH WOMEN'S CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:RENAE
Authorized Official - Middle Name:W
Authorized Official - Last Name:PEMBERTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-804-8124
Mailing Address - Street 1:DEPT 1244
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80291-0001
Mailing Address - Country:US
Mailing Address - Phone:303-486-5500
Mailing Address - Fax:303-486-5501
Practice Address - Street 1:8671 S QUEBEC ST
Practice Address - Street 2:SUITE 220
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80130
Practice Address - Country:US
Practice Address - Phone:303-346-4444
Practice Address - Fax:303-346-4411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-16
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C453748Medicare PIN
COC453748Medicare PIN