Healthcare Provider Details

I. General information

NPI: 1821562109
Provider Name (Legal Business Name): ANGEL HEART TRANSPORTATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2019
Last Update Date: 02/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 E LASALLE ST STE 214
COLORADO SPRINGS CO
80909-0000
US

IV. Provider business mailing address

2210 E LASALLE ST STE 214
COLORADO SPRINGS CO
80909-0000
US

V. Phone/Fax

Practice location:
  • Phone: 719-650-8221
  • Fax:
Mailing address:
  • Phone: 719-650-8221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: MRS. BRITTANY NICHOLE ALSHAWY
Title or Position: ONWER
Credential:
Phone: 719-650-8221