Provider Demographics
NPI:1437396199
Name:ST JUDE EMS, INC.
Entity Type:Organization
Organization Name:ST JUDE EMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PERALES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:281-658-3990
Mailing Address - Street 1:8230 BONNER DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77017-4704
Mailing Address - Country:US
Mailing Address - Phone:281-658-3990
Mailing Address - Fax:713-454-0303
Practice Address - Street 1:8230 BONNER DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77017-4704
Practice Address - Country:US
Practice Address - Phone:281-658-3990
Practice Address - Fax:713-454-0303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000200341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAMB810OtherMEDICARE PROVIDER NUMBER