Provider Demographics
NPI:1629361738
Name:MAKA EMS SERVICE LLC
Entity Type:Organization
Organization Name:MAKA EMS SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEBASTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSOMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-647-1461
Mailing Address - Street 1:8989 WESTHEIMER RD
Mailing Address - Street 2:SUITE 338
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-3621
Mailing Address - Country:US
Mailing Address - Phone:832-647-1461
Mailing Address - Fax:832-431-4308
Practice Address - Street 1:8989 WESTHEIMER RD
Practice Address - Street 2:SUITE 338
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-3621
Practice Address - Country:US
Practice Address - Phone:832-647-1461
Practice Address - Fax:832-431-4308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-23
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000612341600000X, 3416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAMB1266Medicare PIN