MEDICARE: IMPM SAFERIDE 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	343800000X	Secured Medical Transport (VAN)

General Provider Information

NPI Number	:	1669108528
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMPM SAFERIDE LLC

Provider Business Mailing Address
First Line	:	2424 SAWYER HEIGHTS ST APT 323
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-7544
Country	:	US
Telephone Number	:	832-274-5688
Fax Number	:

Provider Business Practice Location Address
First Line	:	2424 SAWYER HEIGHTS ST APT 323
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-7544
Country	:	US
Telephone Number	:	832-274-5688
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	IMEEN MANAHAN-VASQUEZ
Credential	:
Telephone Number	:	832-274-5688

Provider Enumeration Date	:	07/25/2022
Last Update Date	:	07/25/2022

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Directions to “IMPM SAFERIDE LLC ” Practice Location

Language	Start Address	Practice Location

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