MEDICARE: MILE HIGH AMBULANCE, 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	341600000X	Ambulance
2	3416L0300X	Land Ambulance

General Provider Information

NPI Number	:	1487928040
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILE HIGH AMBULANCE, LLC

Provider Business Mailing Address
First Line	:	PO BOX 22440
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-0440
Country	:	US
Telephone Number	:	303-564-6636
Fax Number	:

Provider Business Practice Location Address
First Line	:	8451 BRIGHTON RD
Second Line	:
City	:	COMMERCE CITY
State	:	CO
Zip	:	80022-5309
Country	:	US
Telephone Number	:	303-564-6636
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED SIGNER
Name	:	IGOR BALABAN
Credential	:
Telephone Number	:	303-564-6636

Provider Enumeration Date	:	02/29/2012
Last Update Date	:	01/27/2020

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