Provider Demographics
NPI:1497136295
Name:BASTRO LLC
Entity Type:Organization
Organization Name:BASTRO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GIRUM
Authorized Official - Middle Name:
Authorized Official - Last Name:ZENEBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-588-4610
Mailing Address - Street 1:2002 WAR ADMIRAL DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-6334
Mailing Address - Country:US
Mailing Address - Phone:713-588-4610
Mailing Address - Fax:713-588-4611
Practice Address - Street 1:2002 WAR ADMIRAL DR
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-6334
Practice Address - Country:US
Practice Address - Phone:713-588-4610
Practice Address - Fax:713-588-4611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)