Provider Demographics
NPI:1871123869
Name:MILESTONE PSYCHIATRY INC
Entity type:Organization
Organization Name:MILESTONE PSYCHIATRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SWARTHOUT
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:719-465-2975
Mailing Address - Street 1:5615 CONSTITUTION AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80915-1218
Mailing Address - Country:US
Mailing Address - Phone:719-465-2819
Mailing Address - Fax:719-465-2975
Practice Address - Street 1:5615 CONSTITUTION AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80915-1218
Practice Address - Country:US
Practice Address - Phone:719-465-2819
Practice Address - Fax:719-465-2975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-19
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000193560Medicaid