Healthcare Provider Details

I. General information

NPI: 1376037002
Provider Name (Legal Business Name): TRANS VOYAGE TAXI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 S HAVANA ST STE 712
AURORA CO
80012-4034
US

IV. Provider business mailing address

1450 S HAVANA ST STE 712
AURORA CO
80012-4034
US

V. Phone/Fax

Practice location:
  • Phone: 303-353-4482
  • Fax:
Mailing address:
  • Phone: 303-353-4482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number55921
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number55921
License Number StateCO

VIII. Authorized Official

Name: MOHAMED GAD
Title or Position: EXECUTIVE MANAGER OF OPERATIONS
Credential:
Phone: 720-335-7707