Provider Demographics
NPI:1538688999
Name:OWNER
Entity Type:Organization
Organization Name:OWNER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ESKINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:WELDEGIORGIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-612-0815
Mailing Address - Street 1:14179 E KENTUCKY PL APT 102
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-3665
Mailing Address - Country:US
Mailing Address - Phone:720-612-0815
Mailing Address - Fax:
Practice Address - Street 1:5421 ODESSA ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80249-8393
Practice Address - Country:US
Practice Address - Phone:720-612-0815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-15
Last Update Date:2017-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)