Provider Demographics
NPI:1477934388
Name:AMAZING WHEELS
Entity Type:Organization
Organization Name:AMAZING WHEELS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GENNADIY
Authorized Official - Middle Name:
Authorized Official - Last Name:GNATYUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-495-0256
Mailing Address - Street 1:PO BOX 24312
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-0312
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3090 S JAMAICA CT
Practice Address - Street 2:209
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-2658
Practice Address - Country:US
Practice Address - Phone:720-495-0256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-16
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COB-9937343900000X
CO347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO32871546Medicaid