Healthcare Provider Details

I. General information

NPI: 1912638057
Provider Name (Legal Business Name): HIGH COUNTRY INFUSION & WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2022
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 MAIN ST # 216
FRISCO CO
80443-5929
US

IV. Provider business mailing address

1685 S COLORADO BLVD UNIT S108
DENVER CO
80222-4000
US

V. Phone/Fax

Practice location:
  • Phone: 970-485-4573
  • Fax: 970-406-5086
Mailing address:
  • Phone: 970-485-4573
  • Fax: 970-406-5086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MANDY GLASMEYER
Title or Position: OWNER
Credential: CRNA
Phone: 970-485-4573