Provider Demographics
NPI:1548244361
Name:STAT SERVICES OF JEFFERSON COUNTY A, LLP
Entity Type:Organization
Organization Name:STAT SERVICES OF JEFFERSON COUNTY A, LLP
Other - Org Name:STAT CARE EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR BILLING - OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-833-3834
Mailing Address - Street 1:PO BOX 552
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77704-0552
Mailing Address - Country:US
Mailing Address - Phone:409-833-3834
Mailing Address - Fax:409-833-2060
Practice Address - Street 1:3720 CORLEY ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-6431
Practice Address - Country:US
Practice Address - Phone:409-833-3834
Practice Address - Fax:409-833-2060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123036341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXGTPA1OtherTEXAN PLUS
TX18998OtherUSFHP TEXAS
TX80705OtherGREAT WEST
TXGTPA1OtherENCORE ENCORE
TXGTPA1OtherSELECT CARE OF TX
P00086266OtherRAILROAD MEDICARE
TX163505401Medicaid
TXGTPA1OtherSECURE HORIZONS
TX105453300OtherUS DEPT OF LABOR WC
TX1430324OtherTEXAS HEALTHSPRINGS
TXAMB699OtherBLUE CROSS BLUE SHIELD
TXGTPA1OtherTEXAN PLUS
TX18998OtherUSFHP TEXAS
P00086266OtherRAILROAD MEDICARE