MEDICARE: IMMACULATE 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	332BD1200X	Dialysis Equipment & Supplies (DME)

General Provider Information

NPI Number	:	1821276056
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMMACULATE EMS, INC

Provider Business Mailing Address
First Line	:	PO BOX 570185
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77257-0185
Country	:	US
Telephone Number	:	832-419-1199
Fax Number	:

Provider Business Practice Location Address
First Line	:	9001 AIRPORT BLVD STE 703
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77061-3447
Country	:	US
Telephone Number	:	832-419-1199
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	CHRISTOPHER ANANI
Credential	:
Telephone Number	:	832-419-1199

Provider Enumeration Date	:	02/11/2008
Last Update Date	:	07/09/2009

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