Provider Demographics
NPI:1659541795
Name:MILE HIGH MEDICAL SERVICE
Entity Type:Organization
Organization Name:MILE HIGH MEDICAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTWONETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:PROTHRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-621-2041
Mailing Address - Street 1:4340 E KENTUCKY AVE
Mailing Address - Street 2:SUITE 446
Mailing Address - City:GLENDALE
Mailing Address - State:CO
Mailing Address - Zip Code:80246-2060
Mailing Address - Country:US
Mailing Address - Phone:720-621-2041
Mailing Address - Fax:
Practice Address - Street 1:4340 E KENTUCKY AVE
Practice Address - Street 2:SUITE 446
Practice Address - City:GLENDALE
Practice Address - State:CO
Practice Address - Zip Code:80246-2060
Practice Address - Country:US
Practice Address - Phone:720-621-2041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO091720251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health