Basic Information
| Provider Information | |||||||||
| NPI: | 1649676602 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MILE HIGH SURGERY CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5351 S ROSLYN ST | ||||||||
| Address2: | 300 | ||||||||
| City: | GREENWOOD VILLAGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801112111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3032219500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5351 S ROSLYN ST | ||||||||
| Address2: | 300 | ||||||||
| City: | GREENWOOD VILLAGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801112111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3032219500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2014 | ||||||||
| LastUpdateDate: | 03/24/2015 | ||||||||
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| AuthorizedOfficialLastName: | MACDONALD | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3032219500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.