Healthcare Provider Details

I. General information

NPI: 1801357322
Provider Name (Legal Business Name): NEGASSE MEBRAHTU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 03/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17928 E 44TH AVE
DENVER CO
80249-7611
US

IV. Provider business mailing address

1450 S HAVANA ST STE 610
AURORA CO
80012-4032
US

V. Phone/Fax

Practice location:
  • Phone: 720-288-5143
  • Fax:
Mailing address:
  • Phone: 720-288-5143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: