Provider Demographics
NPI:1366099020
Name:MILE HIGH PSYCHIATRY LLC
Entity type:Organization
Organization Name:MILE HIGH PSYCHIATRY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PSYCHIATRIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:CHISM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-507-4779
Mailing Address - Street 1:15355 E COLFAX AVE UNIT 111717
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80042-1975
Mailing Address - Country:US
Mailing Address - Phone:720-507-4779
Mailing Address - Fax:720-367-5067
Practice Address - Street 1:13430 N SCOTTSDALE RD STE 104-6
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-4057
Practice Address - Country:US
Practice Address - Phone:720-507-4779
Practice Address - Fax:720-367-5067
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MILE HIGH PSYCHIATRY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-19
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty