Provider Demographics
NPI:1396109328
Name:ABEBE, RUTH
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:ABEBE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9029 E MISSISSIPPI AVE
Mailing Address - Street 2:R-304
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-6803
Mailing Address - Country:US
Mailing Address - Phone:443-939-7756
Mailing Address - Fax:
Practice Address - Street 1:9029 E MISSISSIPPI AVE
Practice Address - Street 2:R-304
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-6803
Practice Address - Country:US
Practice Address - Phone:443-939-7756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-06
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO81-0766154Medicaid