MEDICARE: MILE HIGH PSYCHIATRY LLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1366099020
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILE HIGH PSYCHIATRY LLC

Provider Business Mailing Address
First Line	:	15355 E COLFAX AVE UNIT 111717
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80042-1975
Country	:	US
Telephone Number	:	720-507-4779
Fax Number	:	720-367-5067

Provider Business Practice Location Address
First Line	:	13430 N SCOTTSDALE RD STE 104-6
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85254-4057
Country	:	US
Telephone Number	:	720-507-4779
Fax Number	:	720-367-5067

Authorized Official
Title or Position	:	CEO/PSYCHIATRIC DIRECTOR
Name	:	MICHAEL KEITH CHISM
Credential	:
Telephone Number	:	720-507-4779

Provider Enumeration Date	:	08/19/2019
Last Update Date	:	11/04/2022

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Directions to “MILE HIGH PSYCHIATRY LLC ” Practice Location

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