Provider Demographics
NPI:1912554858
Name:JOEL TRANSPORT
Entity Type:Organization
Organization Name:JOEL TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEYOUM
Authorized Official - Middle Name:WOLDEMEDHIN
Authorized Official - Last Name:WOLDEMARIAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-882-3972
Mailing Address - Street 1:PO BOX 31442
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80041-0442
Mailing Address - Country:US
Mailing Address - Phone:720-882-3972
Mailing Address - Fax:
Practice Address - Street 1:6299 N FUNDY ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80019-2125
Practice Address - Country:US
Practice Address - Phone:720-882-3972
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02947OtherPUC