Provider Demographics
NPI:1750820155
Name:WSA TRANSPORT LLC
Entity type:Organization
Organization Name:WSA TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDELSALAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-503-3838
Mailing Address - Street 1:5400 MONROE ST.
Mailing Address - Street 2:
Mailing Address - City:COMMERCE CITY
Mailing Address - State:CO
Mailing Address - Zip Code:80022
Mailing Address - Country:US
Mailing Address - Phone:303-503-3838
Mailing Address - Fax:
Practice Address - Street 1:5400 MONROE ST
Practice Address - Street 2:
Practice Address - City:COMMERCE CITY
Practice Address - State:CO
Practice Address - Zip Code:80022-2434
Practice Address - Country:US
Practice Address - Phone:303-503-3838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41989261343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO41989261Medicaid