Provider Demographics
NPI:1407872856
Name:ST. JOSEPH'S AMBULANCE SERVICE, INC.
Entity Type:Organization
Organization Name:ST. JOSEPH'S AMBULANCE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:J
Authorized Official - Last Name:PERALTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-922-5116
Mailing Address - Street 1:P.O. BOX 891449
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77289-1449
Mailing Address - Country:US
Mailing Address - Phone:281-286-6331
Mailing Address - Fax:281-922-4234
Practice Address - Street 1:15255 GULF FRWY
Practice Address - Street 2:STE 145-D
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77034
Practice Address - Country:US
Practice Address - Phone:281-268-6331
Practice Address - Fax:281-922-4234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1014083416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00000MDXOOtherBLUE CROSS/BLUE SHIELD
TXP00163859OtherRAILROAD MEDICAID
TX167195001Medicaid
TX167195001Medicaid