Provider Demographics
NPI:1962042192
Name:PETRA MEDICARE TRANSPORTATION LLC
Entity Type:Organization
Organization Name:PETRA MEDICARE TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IBRAHIM
Authorized Official - Middle Name:
Authorized Official - Last Name:KAKISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-405-6765
Mailing Address - Street 1:1425 W KEMPER RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-1630
Mailing Address - Country:US
Mailing Address - Phone:513-405-6765
Mailing Address - Fax:
Practice Address - Street 1:1425 W KEMPER RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-1630
Practice Address - Country:US
Practice Address - Phone:513-405-6765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)