Provider Demographics
NPI:1396295176
Name:IMANI MEDICAL TRANSPORTATION LLC
Entity type:Organization
Organization Name:IMANI MEDICAL TRANSPORTATION LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:HUMPHREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:346-248-8348
Mailing Address - Street 1:14427 BENNINGCREST LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77047-7527
Mailing Address - Country:US
Mailing Address - Phone:346-248-8348
Mailing Address - Fax:832-553-7811
Practice Address - Street 1:5718 WESTHEIMER RD STE 1000
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-9903
Practice Address - Country:US
Practice Address - Phone:346-248-8348
Practice Address - Fax:832-553-7811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-05
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX309244702Medicaid