Provider Demographics
NPI:1720376429
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:SVP OF REVENUE MANAGEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-288-5340
Mailing Address - Street 1:PO BOX 277
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35201-0277
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4951 AIRPORT PKWY STE 710
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-6616
Practice Address - Country:US
Practice Address - Phone:214-254-4089
Practice Address - Fax:205-380-2074
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFEGUARD AMBULANCE SERVICE OF TEXAS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-14
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3416L0300X
TX1000665341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1720376429OtherTRICARE SOUTH
TXAMB1385OtherBCBS-TX- DALLAS
AM1284OtherBCBS -TX - HOUSTON
TX286168401Medicaid
TXAMB1206Medicare PIN
TXP00981651OtherRAILROAD MEDICARE
TXAMB1427Medicare PIN