Provider Demographics
NPI:1699854463
Name:MILE HIGH OTOLARYNGOLOGY
Entity Type:Organization
Organization Name:MILE HIGH OTOLARYNGOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BEATTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-487-0834
Mailing Address - Street 1:6870 W 52ND AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-3953
Mailing Address - Country:US
Mailing Address - Phone:303-487-0834
Mailing Address - Fax:303-487-6932
Practice Address - Street 1:6870 W 52ND AVE STE 207
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002
Practice Address - Country:US
Practice Address - Phone:303-487-0834
Practice Address - Fax:303-487-6932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01273838Medicaid
COMI653802Medicaid
CO01361898Medicaid
COE90278Medicare ID - Type UnspecifiedDR DART
CO01361898Medicaid
CO01273838Medicaid
COE90278Medicare UPIN