Provider Demographics
NPI:1275624967
Name:ALLSTATE EMS AMBULANCE SERVICE INC
Entity Type:Organization
Organization Name:ALLSTATE EMS AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-691-7311
Mailing Address - Street 1:4207 GARDENDALE ST
Mailing Address - Street 2:101-B
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3182
Mailing Address - Country:US
Mailing Address - Phone:713-691-7311
Mailing Address - Fax:713-691-7313
Practice Address - Street 1:6365 MILLERVIEW DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77091-3358
Practice Address - Country:US
Practice Address - Phone:713-691-7311
Practice Address - Fax:713-691-7313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101224341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140464201Medicaid
TXAMB139Medicare ID - Type UnspecifiedMEDICARE