Provider Demographics
NPI:1225816671
Name:MELESE, KIBROM
Entity Type:Individual
Prefix:
First Name:KIBROM
Middle Name:
Last Name:MELESE
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 1:1620 9TH AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-5632
Mailing Address - Country:US
Mailing Address - Phone:720-486-2876
Mailing Address - Fax:
Practice Address - Street 1:1620 9TH AVE APT 6
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-5632
Practice Address - Country:US
Practice Address - Phone:720-486-2876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)