Provider Demographics
NPI:1265297345
Name:PIKES PEAK MEDICAL TRANSPORT LLC
Entity type:Organization
Organization Name:PIKES PEAK MEDICAL TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MESELE
Authorized Official - Middle Name:BELIHU
Authorized Official - Last Name:HAILEMARKOSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-917-6827
Mailing Address - Street 1:4965 S HALEYVILLE ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-4259
Mailing Address - Country:US
Mailing Address - Phone:720-917-6827
Mailing Address - Fax:
Practice Address - Street 1:1710 BRIARGATE BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3449
Practice Address - Country:US
Practice Address - Phone:720-917-6827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)