Healthcare Provider Details

I. General information

NPI: 1740883958
Provider Name (Legal Business Name): MILE HIGH PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2020
Last Update Date: 11/19/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

848 N RAINBOW BLVD # 228
LAS VEGAS NV
89107-1103
US

IV. Provider business mailing address

15355 E COLFAX AVE UNIT 111717
AURORA CO
80042-1975
US

V. Phone/Fax

Practice location:
  • Phone: 720-507-4779
  • Fax: 720-367-5067
Mailing address:
  • Phone: 720-507-4779
  • Fax: 720-367-5067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL K CHISM II
Title or Position: NP/CEO
Credential:
Phone: 720-507-4779