Provider Demographics
NPI:1982161592
Name:ETHIO TRANSPORTATION,LLC
Entity Type:Organization
Organization Name:ETHIO TRANSPORTATION,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ESTIFANOS
Authorized Official - Middle Name:GOSSAYE
Authorized Official - Last Name:DAGNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:857-294-2029
Mailing Address - Street 1:6360 SHOOTING IRON WAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-7439
Mailing Address - Country:US
Mailing Address - Phone:857-294-2029
Mailing Address - Fax:
Practice Address - Street 1:6360 SHOOTING IRON WAY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-7439
Practice Address - Country:US
Practice Address - Phone:857-294-2029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-01
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)