Provider Demographics
NPI:1801993761
Name:MILE HIGH OB GYN ASSOC PC
Entity type:Organization
Organization Name:MILE HIGH OB GYN ASSOC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LALICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-239-0309
Mailing Address - Street 1:PO BOX 461309
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-5309
Mailing Address - Country:US
Mailing Address - Phone:303-388-4631
Mailing Address - Fax:303-320-6961
Practice Address - Street 1:425 S CHERRY ST STE 300
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1230
Practice Address - Country:US
Practice Address - Phone:303-388-4631
Practice Address - Fax:303-320-6961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO16572769Medicaid
CO16572769Medicaid
COC325208Medicare PIN