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General NPI Number Information
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NPI Number | 1528204054
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Entity Type | Organization
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Legal Business Name | COLUMBINE EXPRESS
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Dates
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Enumeration Date | 01/06/2009
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Last Update Date | 01/06/2009
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Provider Practice Location Address
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Address Line | 13228 W JEWELL PL
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City | LAKEWOOD
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State | CO
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Zip | 80228-4222
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Country | US
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Telephone | 303-952-0383
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Fax |
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Provider Business Mailing Address
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Address Line | 13228 W JEWELL PL
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City | LAKEWOOD
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State | CO
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Zip | 80228-4222
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Country | US
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Telephone | 303-952-0383
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. SERGEY TKACHENKO
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Credential |
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Telephone | 303-933-1260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | B-9910
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License Number State | CO
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