MEDICARE: MILE HI IMMUNIZATIONS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1063729408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILE HI IMMUNIZATIONS, INC

Provider Business Mailing Address
First Line	:	283 COLUMBINE ST
Second Line	:	#150
City	:	DENVER
State	:	CO
Zip	:	80206-4707
Country	:	US
Telephone Number	:	303-374-3374
Fax Number	:

Provider Business Practice Location Address
First Line	:	283 COLUMBINE ST
Second Line	:	#150
City	:	DENVER
State	:	CO
Zip	:	80206-4707
Country	:	US
Telephone Number	:	303-374-3374
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SUNNY ALLISON HYNDS
Credential	:
Telephone Number	:	303-374-3374

Provider Enumeration Date	:	09/07/2010
Last Update Date	:	08/06/2012

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