MEDICARE: MILE HIGH LIMO LLLC

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	171W00000X	Contractor	20151668889	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2015166889	OTHER	CO	PROVIDER

General Provider Information

NPI Number	:	1043700917
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILE HIGH LIMO LLLC

Provider Business Mailing Address
First Line	:	5089 CENTRAL PARK BLVD
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80238-4189
Country	:	US
Telephone Number	:	720-206-8178
Fax Number	:	720-428-8336

Provider Business Practice Location Address
First Line	:	5089 CENTRAL PARK BLVD
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80238-4189
Country	:	US
Telephone Number	:	720-206-8178
Fax Number	:	720-428-8336

Authorized Official
Title or Position	:	OWNER
Name	:	ADINO D BOGALE
Credential	:
Telephone Number	:	720-206-8178

Provider Enumeration Date	:	05/15/2018
Last Update Date	:	09/12/2023

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Directions to “MILE HIGH LIMO LLLC ” Practice Location

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