MEDICARE: TEWODROS B FOLLA

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)	20201145245	CO

General Provider Information

NPI Number	:	1730712720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEWODROS B FOLLA

Provider Business Mailing Address
First Line	:	10808 TROY ST
Second Line	:
City	:	COMMERCE CITY
State	:	CO
Zip	:	80022-6639
Country	:	US
Telephone Number	:	303-994-1503
Fax Number	:

Provider Business Practice Location Address
First Line	:	10808 TROY ST
Second Line	:
City	:	COMMERCE CITY
State	:	CO
Zip	:	80022-6639
Country	:	US
Telephone Number	:	303-994-1503
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/18/2020
Last Update Date	:	02/18/2020

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Directions to “ TEWODROS B FOLLA ” Practice Location

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