MEDICARE: LASAFAT EMS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	1000740	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1000740	OTHER	TX	TEXAS DEPARTMENT OF STATE HEALTH SERVICES

General Provider Information

NPI Number	:	1003172875
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LASAFAT EMS INC

Provider Business Mailing Address
First Line	:	1941 7TH ST
Second Line	:	SUITE A
City	:	BAY CITY
State	:	TX
Zip	:	77414-4237
Country	:	US
Telephone Number	:	979-323-0516
Fax Number	:	713-771-5081

Provider Business Practice Location Address
First Line	:	1941 7TH ST
Second Line	:	SUITE A
City	:	BAY CITY
State	:	TX
Zip	:	77414-4237
Country	:	US
Telephone Number	:	979-323-0516
Fax Number	:	713-771-5081

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ORA ABBOTT
Credential	:
Telephone Number	:	979-323-0516

Provider Enumeration Date	:	04/05/2012
Last Update Date	:	04/05/2012

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