Provider Demographics
NPI:1487928040
Name:MILE HIGH AMBULANCE, LLC
Entity type:Organization
Organization Name:MILE HIGH AMBULANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED SIGNER
Authorized Official - Prefix:
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:BALABAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-564-6636
Mailing Address - Street 1:PO BOX 22440
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-0440
Mailing Address - Country:US
Mailing Address - Phone:303-564-6636
Mailing Address - Fax:
Practice Address - Street 1:8451 BRIGHTON RD
Practice Address - Street 2:
Practice Address - City:COMMERCE CITY
Practice Address - State:CO
Practice Address - Zip Code:80022-5309
Practice Address - Country:US
Practice Address - Phone:303-564-6636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-29
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance