Provider Demographics
NPI:1538706122
Name:MILE HIGH PSYCHIATRY LLC
Entity Type:Organization
Organization Name:MILE HIGH PSYCHIATRY LLC
Other - Org Name:MILE HIGH PSYCHIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO AND PSYCHIATRIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:CHISM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-507-4779
Mailing Address - Street 1:15355 E COLFAX AVE UNIT 111717
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80042-1975
Mailing Address - Country:US
Mailing Address - Phone:720-507-4779
Mailing Address - Fax:
Practice Address - Street 1:8089 S LINCOLN ST STE 207
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2720
Practice Address - Country:US
Practice Address - Phone:720-507-4779
Practice Address - Fax:720-367-5067
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MILE HIGH PSYCHIATRY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-03
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty