Provider Demographics
NPI:1316920911
Name:KMTM ENTERPRISES, INC
Entity type:Organization
Organization Name:KMTM ENTERPRISES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:MORTAZAVI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-871-1131
Mailing Address - Street 1:2121 SAGE ROAD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-4326
Mailing Address - Country:US
Mailing Address - Phone:713-871-1131
Mailing Address - Fax:713-871-1194
Practice Address - Street 1:2121 SAGE ROAD
Practice Address - Street 2:SUITE 225
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-4326
Practice Address - Country:US
Practice Address - Phone:713-871-1131
Practice Address - Fax:713-871-1194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-29
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX002881251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45-8099Medicare PIN