Provider Demographics
NPI:1316541063
Name:NEAT MEDIC
Entity Type:Organization
Organization Name:NEAT MEDIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:DITU
Authorized Official - Last Name:KAYEMBE
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:832-714-9560
Mailing Address - Street 1:1926 ACORN GLEN TRL
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-2121
Mailing Address - Country:US
Mailing Address - Phone:832-714-9560
Mailing Address - Fax:
Practice Address - Street 1:1926 ACORN GLEN TRL
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:TX
Practice Address - Zip Code:77545-2121
Practice Address - Country:US
Practice Address - Phone:832-714-9560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No344600000XTransportation ServicesTaxi
No347C00000XTransportation ServicesPrivate Vehicle
No347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1396307302Medicaid