| Miles Medical Group Llc | |
|
1942 Broadway Ste 314c Boulder CO 80302-5233 | |
| (970) 306-6819 | |
| (650) 374-5584 |
| Full Name | Miles Medical Group Llc |
|---|---|
| Speciality | General Practice |
| Location | 1942 Broadway Ste 314c, Boulder, Colorado |
| Authorized Official Name and Position | Hannah Labove (PHYSICIAN) |
| Authorized Official Contact | 9703066819 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Miles Medical Group Llc 1441 Little Raven St Denver CO 80202-6427 Ph: (973) 886-4872 | Miles Medical Group Llc 1942 Broadway Ste 314c Boulder CO 80302-5233 Ph: (970) 306-6819 |
| NPI Number | 1215641683 |
|---|---|
| Provider Enumeration Date | 01/10/2023 |
| Last Update Date | 01/03/2024 |
| Medicare PECOS PAC ID | 5698147254 |
|---|---|
| Medicare Enrollment ID | O20230207002772 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215641683 | NPI | - | NPPES |
| 1477087146 | Medicaid | CO | |
| 1477087146 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Hannah Labove |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1477087146 PECOS PAC ID: 3274944343 Enrollment ID: I20201120000444 |
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