Provider Demographics
NPI:1467817833
Name:SS TRANSPORTATION
Entity Type:Organization
Organization Name:SS TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER(MANAGER)
Authorized Official - Prefix:
Authorized Official - First Name:SINTAYEHU
Authorized Official - Middle Name:ADERA
Authorized Official - Last Name:TADESSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-273-7889
Mailing Address - Street 1:8841 E FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-2831
Mailing Address - Country:US
Mailing Address - Phone:720-273-7889
Mailing Address - Fax:719-362-4102
Practice Address - Street 1:1602 S PARKER RD
Practice Address - Street 2:SUTE 101
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-2919
Practice Address - Country:US
Practice Address - Phone:720-492-3934
Practice Address - Fax:719-362-4102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COB-09995343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06753019Medicaid