Provider Demographics
NPI:1528204054
Name:COLUMBINE EXPRESS
Entity Type:Organization
Organization Name:COLUMBINE EXPRESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SERGEY
Authorized Official - Middle Name:
Authorized Official - Last Name:TKACHENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-933-1260
Mailing Address - Street 1:13228 W JEWELL PL
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-4222
Mailing Address - Country:US
Mailing Address - Phone:303-952-0383
Mailing Address - Fax:
Practice Address - Street 1:13228 W JEWELL PL
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-4222
Practice Address - Country:US
Practice Address - Phone:303-952-0383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COB-9910343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)