Provider Demographics
NPI:1194760496
Name:IMMACULATE EMS,INC.
Entity type:Organization
Organization Name:IMMACULATE EMS,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIERECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:KOLA
Authorized Official - Last Name:ANANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-419-1199
Mailing Address - Street 1:301 S 9TH ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-3448
Mailing Address - Country:US
Mailing Address - Phone:832-344-5229
Mailing Address - Fax:832-344-9541
Practice Address - Street 1:301 S 9TH ST
Practice Address - Street 2:SUITE 205
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-3448
Practice Address - Country:US
Practice Address - Phone:832-344-5229
Practice Address - Fax:832-344-9541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8000973416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport