Provider Demographics
NPI:1740500354
Name:COLUMBINE INVACAB SERVICE
Entity type:Organization
Organization Name:COLUMBINE INVACAB SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CISSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-794-1911
Mailing Address - Street 1:2453 W CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-1903
Mailing Address - Country:US
Mailing Address - Phone:303-794-1911
Mailing Address - Fax:303-798-3670
Practice Address - Street 1:2453 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-1903
Practice Address - Country:US
Practice Address - Phone:303-794-1911
Practice Address - Fax:303-798-3670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-04
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO06001002343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)