Provider Demographics
NPI:1740649789
Name:MILE HIGH AUDIOLOGY, INC.
Entity type:Organization
Organization Name:MILE HIGH AUDIOLOGY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CIVIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-A, FAAA
Authorized Official - Phone:303-810-3774
Mailing Address - Street 1:200 UNION BLVD
Mailing Address - Street 2:SUITE 421
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1830
Mailing Address - Country:US
Mailing Address - Phone:720-446-2828
Mailing Address - Fax:720-446-0941
Practice Address - Street 1:200 UNION BLVD
Practice Address - Street 2:SUITE 421
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1830
Practice Address - Country:US
Practice Address - Phone:720-446-2828
Practice Address - Fax:720-446-0941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-18
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAUD-218231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO29451281Medicaid