Provider Demographics
NPI:1225503907
Name:AVILA MEDICAL TRANSPORT LLC
Entity Type:Organization
Organization Name:AVILA MEDICAL TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ARIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-230-7286
Mailing Address - Street 1:2813 DAY BREAK AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-4888
Mailing Address - Country:US
Mailing Address - Phone:970-210-7083
Mailing Address - Fax:
Practice Address - Street 1:2813 DAY BREAK AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-4888
Practice Address - Country:US
Practice Address - Phone:970-210-7083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000143948Medicaid