Provider Demographics
NPI:1821185620
Name:MILE HIGH MEDICAL SUPPLY
Entity Type:Organization
Organization Name:MILE HIGH MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNWE MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GARNET
Authorized Official - Middle Name:DEVON
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-750-0512
Mailing Address - Street 1:1562 S PARKER RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-2718
Mailing Address - Country:US
Mailing Address - Phone:303-750-0512
Mailing Address - Fax:303-750-0512
Practice Address - Street 1:1562 S PARKER RD
Practice Address - Street 2:SUITE 114
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-2718
Practice Address - Country:US
Practice Address - Phone:303-750-0512
Practice Address - Fax:303-750-0512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO16424557Medicaid
CO5634910001Medicare ID - Type UnspecifiedPROVIDER ID