Provider Demographics
NPI:1447641279
Name:TAZCO, INC.
Entity type:Organization
Organization Name:TAZCO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-558-1249
Mailing Address - Street 1:PO BOX 717
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81502-0717
Mailing Address - Country:US
Mailing Address - Phone:970-361-3130
Mailing Address - Fax:970-361-3130
Practice Address - Street 1:1321 UTE AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-4619
Practice Address - Country:US
Practice Address - Phone:970-361-3130
Practice Address - Fax:970-361-3130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-16
Last Update Date:2021-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19429344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04143020Medicaid
CO06001218Medicaid