Provider Demographics
NPI:1902670706
Name:ZOOM MEDICAID TRANSPORTATION LLC
Entity Type:Organization
Organization Name:ZOOM MEDICAID TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-859-3576
Mailing Address - Street 1:9533 COUNTY ROAD 67.5
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082-9725
Mailing Address - Country:US
Mailing Address - Phone:719-859-3576
Mailing Address - Fax:
Practice Address - Street 1:9533 COUNTY ROAD 67.5
Practice Address - Street 2:
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-9725
Practice Address - Country:US
Practice Address - Phone:719-859-3576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company