Provider Demographics
NPI:1407206725
Name:INTERNAL MEDICINE CENTER
Entity type:Organization
Organization Name:INTERNAL MEDICINE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTNOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-345-8291
Mailing Address - Street 1:9301 POUNDSTONE PL
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-3410
Mailing Address - Country:US
Mailing Address - Phone:303-345-8291
Mailing Address - Fax:720-914-1010
Practice Address - Street 1:8210 SOUTHPARK TER
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-5614
Practice Address - Country:US
Practice Address - Phone:303-345-8291
Practice Address - Fax:720-914-1010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-17
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO69412529Medicaid
COPENDINGMedicaid