MEDICARE: ESTES PARK TAKXI 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	:	1821639956
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESTES PARK TAKXI LLC

Provider Business Mailing Address
First Line	:	1050 S SAINT VRAIN AVE UNIT F1
Second Line	:
City	:	ESTES PARK
State	:	CO
Zip	:	80517-7465
Country	:	US
Telephone Number	:	303-214-8939
Fax Number	:

Provider Business Practice Location Address
First Line	:	1050 S SAINT VRAIN AVE UNIT F1
Second Line	:
City	:	ESTES PARK
State	:	CO
Zip	:	80517-7465
Country	:	US
Telephone Number	:	303-214-8939
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GEBRESLASIE GEBREKIDAN
Credential	:
Telephone Number	:	303-214-8939

Provider Enumeration Date	:	09/30/2019
Last Update Date	:	09/30/2019

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