MEDICARE: PIKES PEAK MEDICAL TRANSPORT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1265297345
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIKES PEAK MEDICAL TRANSPORT LLC

Provider Business Mailing Address
First Line	:	4965 S HALEYVILLE ST
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80016-4259
Country	:	US
Telephone Number	:	720-917-6827
Fax Number	:

Provider Business Practice Location Address
First Line	:	1710 BRIARGATE BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3449
Country	:	US
Telephone Number	:	720-917-6827
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MESELE BELIHU HAILEMARKOSE
Credential	:
Telephone Number	:	720-917-6827

Provider Enumeration Date	:	02/16/2024
Last Update Date	:	02/16/2024

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Directions to “PIKES PEAK MEDICAL TRANSPORT LLC ” Practice Location

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