Provider Demographics
NPI:1831702083
Name:MAYTA HEALTH SYSTEMS LLC
Entity type:Organization
Organization Name:MAYTA HEALTH SYSTEMS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:SETOR
Authorized Official - Middle Name:
Authorized Official - Last Name:AKATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-237-3010
Mailing Address - Street 1:610 N FORT WORTH ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-4873
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2101 N MIDLAND DR STE 14B
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-5507
Practice Address - Country:US
Practice Address - Phone:432-237-3010
Practice Address - Fax:432-237-3020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-27
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150355Medicaid