Provider Demographics
NPI:1396003513
Name:LIFEGUARD AMBULANCE SERVICE OF TEXAS LLC
Entity Type:Organization
Organization Name:LIFEGUARD AMBULANCE SERVICE OF TEXAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:ROCHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-949-1719
Mailing Address - Street 1:PO BOX 11361
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35202-1361
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4951 AIRPORT PARKWAY
Practice Address - Street 2:SUITE 710
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-6616
Practice Address - Country:US
Practice Address - Phone:205-380-2065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000665341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance