Provider Demographics
NPI:1992186126
Name:MERIN, MEDEMDEMIA
Entity Type:Individual
Prefix:
First Name:MEDEMDEMIA
Middle Name:
Last Name:MERIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 S GENEVA ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80247-1932
Mailing Address - Country:US
Mailing Address - Phone:720-400-2828
Mailing Address - Fax:720-216-1901
Practice Address - Street 1:808 S GENEVA ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80247-1932
Practice Address - Country:US
Practice Address - Phone:720-400-2828
Practice Address - Fax:720-216-1901
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-12
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COB-10012343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO58722726Medicaid