Provider Demographics
NPI:1093386922
Name:LUEBBEN, CORY
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:
Last Name:LUEBBEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3780 S BROADWAY STE 101
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-3674
Mailing Address - Country:US
Mailing Address - Phone:720-539-7373
Mailing Address - Fax:
Practice Address - Street 1:3780 S BROADWAY STE 101
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3674
Practice Address - Country:US
Practice Address - Phone:720-539-7373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO461785455OtherKEY TRANSIT