Provider Demographics
NPI:1295195113
Name:ST.ARSEMA TRANSPORTATION
Entity Type:Organization
Organization Name:ST.ARSEMA TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DRIVER
Authorized Official - Prefix:
Authorized Official - First Name:BERHANE
Authorized Official - Middle Name:KIDANE
Authorized Official - Last Name:HAGOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-338-1364
Mailing Address - Street 1:1039 S PARKER RD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-2532
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1039 S PARKER RD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-2532
Practice Address - Country:US
Practice Address - Phone:720-338-1364
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-04
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
343900000X
CO2011 -BFN-1056909344600000X
CO2011-BFN-1056909344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No344600000XTransportation ServicesTaxi
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO20151783187Other20151783187