Provider Demographics
NPI:1649676602
Name:MILE HIGH SURGERY CENTER, LLC
Entity type:Organization
Organization Name:MILE HIGH SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MACDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-221-9500
Mailing Address - Street 1:5351 S ROSLYN ST
Mailing Address - Street 2:300
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2111
Mailing Address - Country:US
Mailing Address - Phone:303-221-9500
Mailing Address - Fax:
Practice Address - Street 1:5351 S ROSLYN ST
Practice Address - Street 2:300
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2111
Practice Address - Country:US
Practice Address - Phone:303-221-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-18
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical