Provider Demographics
NPI:1306044490
Name:OPTIMUM CARE EMS, LLC
Entity Type:Organization
Organization Name:OPTIMUM CARE EMS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NIEVES
Authorized Official - Middle Name:
Authorized Official - Last Name:VASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-460-4289
Mailing Address - Street 1:4125 HOLLISTER ST
Mailing Address - Street 2:SUITE M
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77080-3044
Mailing Address - Country:US
Mailing Address - Phone:713-460-1125
Mailing Address - Fax:713-460-1131
Practice Address - Street 1:4125 HOLLISTER ST
Practice Address - Street 2:SUITE M
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77080-3044
Practice Address - Country:US
Practice Address - Phone:713-460-1125
Practice Address - Fax:713-460-1131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10000423416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAMB609Medicare PIN