Provider Demographics
NPI:1821588690
Name:AXEL MEDICAL TRANSPORTATION
Entity Type:Organization
Organization Name:AXEL MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AMMAN
Authorized Official - Middle Name:ABRAHA
Authorized Official - Last Name:TEKLU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-665-4449
Mailing Address - Street 1:PO BOX 15980
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80935-5980
Mailing Address - Country:US
Mailing Address - Phone:720-665-4449
Mailing Address - Fax:
Practice Address - Street 1:2860 S CIRCLE DR STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4133
Practice Address - Country:US
Practice Address - Phone:719-401-7870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-16
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1821588690Medicaid
CO20181313920Medicaid