Provider Demographics
NPI:1689267627
Name:SPARK TRANSPORTATION LLC
Entity Type:Organization
Organization Name:SPARK TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMEDULAMEEN
Authorized Official - Middle Name:AKRAM
Authorized Official - Last Name:MAHMOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-334-0456
Mailing Address - Street 1:25 E 5TH AVE APT 606
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-3478
Mailing Address - Country:US
Mailing Address - Phone:720-334-0456
Mailing Address - Fax:
Practice Address - Street 1:25 E 5TH AVE APT 606
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-3478
Practice Address - Country:US
Practice Address - Phone:720-334-0456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-19
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)