Provider Demographics
NPI:1225420318
Name:BOULDER CREEK TRANSPORTATION, INC.
Entity Type:Organization
Organization Name:BOULDER CREEK TRANSPORTATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:WETZELBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-428-2526
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:CO
Mailing Address - Zip Code:80540-0936
Mailing Address - Country:US
Mailing Address - Phone:720-428-2526
Mailing Address - Fax:
Practice Address - Street 1:103 EAGLE CANYON CIRCLE
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:CO
Practice Address - Zip Code:80540
Practice Address - Country:US
Practice Address - Phone:720-428-2526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO922489529343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)