Provider Demographics
NPI:1952804676
Name:MIDDLE PATH PSYCHIATRY LLC
Entity Type:Organization
Organization Name:MIDDLE PATH PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE-MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-502-5670
Mailing Address - Street 1:950 S CHERRY ST STE 420
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-2664
Mailing Address - Country:US
Mailing Address - Phone:702-502-5670
Mailing Address - Fax:702-502-5679
Practice Address - Street 1:950 S CHERRY ST STE 420
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-2664
Practice Address - Country:US
Practice Address - Phone:702-502-5670
Practice Address - Fax:702-502-5679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-09
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.554172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty