Provider Demographics
NPI:1518744242
Name:MELESE, ESUBALEW ADAM
Entity Type:Individual
Prefix:
First Name:ESUBALEW
Middle Name:ADAM
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 1:2175 ACADEMY CIR STE 8
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1682
Mailing Address - Country:US
Mailing Address - Phone:720-206-8300
Mailing Address - Fax:
Practice Address - Street 1:2175 ACADEMY CIR STE 8
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1682
Practice Address - Country:US
Practice Address - Phone:720-206-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COBRYU07343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)