Healthcare Provider Details

I. General information

NPI: 1225395072
Provider Name (Legal Business Name): ARJIM AUTO EMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 12/18/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2276 BLUE FESCUE CT
COLORADO SPRINGS CO
80915-2034
US

IV. Provider business mailing address

2276 BLUE FESCUE CT
COLORADO SPRINGS CO
80915-2034
US

V. Phone/Fax

Practice location:
  • Phone: 719-258-0093
  • Fax:
Mailing address:
  • Phone: 719-258-0093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberE1841787
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: