Provider Demographics
NPI:1740558956
Name:EAST TEXAS SUPPORT SERVICES INC
Entity Type:Organization
Organization Name:EAST TEXAS SUPPORT SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:JANEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-384-8751
Mailing Address - Street 1:PO BOX 2440
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TX
Mailing Address - Zip Code:75951-0026
Mailing Address - Country:US
Mailing Address - Phone:409-384-8751
Mailing Address - Fax:409-489-0289
Practice Address - Street 1:109 W WATER ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-4423
Practice Address - Country:US
Practice Address - Phone:409-384-8751
Practice Address - Fax:409-489-0289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No251K00000XAgenciesPublic Health or Welfare
No343800000XTransportation ServicesSecured Medical Transport (VAN)