MEDICARE: MAKA EMS SERVICE LLC

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	3416A0800X	Air Ambulance	1000612	TX
2	341600000X	Ambulance	1000612	TX

General Provider Information

NPI Number	:	1629361738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAKA EMS SERVICE LLC

Provider Business Mailing Address
First Line	:	8989 WESTHEIMER RD
Second Line	:	SUITE 338
City	:	HOUSTON
State	:	TX
Zip	:	77063-3621
Country	:	US
Telephone Number	:	832-647-1461
Fax Number	:	832-431-4308

Provider Business Practice Location Address
First Line	:	8989 WESTHEIMER RD
Second Line	:	SUITE 338
City	:	HOUSTON
State	:	TX
Zip	:	77063-3621
Country	:	US
Telephone Number	:	832-647-1461
Fax Number	:	832-431-4308

Authorized Official
Title or Position	:	OWNER
Name	:	SEBASTIAN KASSOMI
Credential	:
Telephone Number	:	832-647-1461

Provider Enumeration Date	:	05/23/2011
Last Update Date	:	08/10/2012

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Directions to “MAKA EMS SERVICE LLC ” Practice Location

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