MEDICARE: DEETRANSPORTATIONCO, 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	347C00000X	Private Vehicle

General Provider Information

NPI Number	:	1801481510
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEETRANSPORTATIONCO, LLC

Provider Business Mailing Address
First Line	:	6292 TWIN OAKS DR APT 2234
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-8331
Country	:	US
Telephone Number	:	719-216-7250
Fax Number	:	719-382-5696

Provider Business Practice Location Address
First Line	:	6292 TWIN OAKS DR APT 2234
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-8331
Country	:	US
Telephone Number	:	719-216-7250
Fax Number	:	719-383-5696

Authorized Official
Title or Position	:	OWNER OPERATOR
Name	:	MR. DEMETRIUS L JEFFERSON
Credential	:
Telephone Number	:	719-216-7250

Provider Enumeration Date	:	03/04/2021
Last Update Date	:	11/30/2022

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