Provider Demographics
NPI:1609842277
Name:MILE HIGH PRIMARY CARE PC
Entity Type:Organization
Organization Name:MILE HIGH PRIMARY CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ESTELLA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-341-4200
Mailing Address - Street 1:2230 S FRASER ST
Mailing Address - Street 2:UNIT 1
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-4535
Mailing Address - Country:US
Mailing Address - Phone:303-341-4200
Mailing Address - Fax:303-341-4480
Practice Address - Street 1:2230 S FRASER ST
Practice Address - Street 2:UNIT 1
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-4535
Practice Address - Country:US
Practice Address - Phone:303-341-4200
Practice Address - Fax:303-341-4480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04013231Medicaid
CO04013231Medicaid