Provider Demographics
NPI:1235652637
Name:TEWODROS KASSA
Entity Type:Organization
Organization Name:TEWODROS KASSA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TEWODROS
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-317-4357
Mailing Address - Street 1:13021 DESSAU RD LOT 196
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-1994
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13021 DESSAU RD LOT 196
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78754-1994
Practice Address - Country:US
Practice Address - Phone:512-317-4357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEWODROS KASSA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-18
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)