MEDICARE: FRAKTAN 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	341600000X	Ambulance	800203	TX

General Provider Information

NPI Number	:	1932278058
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRAKTAN LLC

Provider Business Mailing Address
First Line	:	6209 IMOGENE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-7511
Country	:	US
Telephone Number	:	832-606-1638
Fax Number	:	713-621-9673

Provider Business Practice Location Address
First Line	:	6209 IMOGENE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-7511
Country	:	US
Telephone Number	:	832-606-1638
Fax Number	:	713-621-9673

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	MR. VLADLEN BREGER
Credential	:
Telephone Number	:	832-687-8277

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	08/22/2020

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Directions to “FRAKTAN LLC ” Practice Location

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