Provider Demographics
NPI:1699551127
Name:MILE HIGH DIABETES VEIN AND WOUND CENTER LLC
Entity type:Organization
Organization Name:MILE HIGH DIABETES VEIN AND WOUND CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:WARNER
Authorized Official - Middle Name:
Authorized Official - Last Name:HETTICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-589-1589
Mailing Address - Street 1:12061 TEJON ST STE 600
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-2325
Mailing Address - Country:US
Mailing Address - Phone:303-457-0123
Mailing Address - Fax:303-252-4065
Practice Address - Street 1:12061 TEJON ST STE 600
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-2325
Practice Address - Country:US
Practice Address - Phone:303-457-0123
Practice Address - Fax:303-252-4065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-31
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy