Provider Demographics
NPI:1861481616
Name:ST JOHNS REGIONAL
Entity Type:Organization
Organization Name:ST JOHNS REGIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-838-2273
Mailing Address - Street 1:9630 HOLLOCK ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77075-1806
Mailing Address - Country:US
Mailing Address - Phone:713-838-2273
Mailing Address - Fax:713-838-7088
Practice Address - Street 1:9630 HOLLOCK ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77075-1806
Practice Address - Country:US
Practice Address - Phone:713-838-2273
Practice Address - Fax:713-838-7088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-14
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101307341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0000AMB676OtherBCBS PROVIDER NUMBER
TX159236201Medicaid
TXAMB317Medicare ID - Type UnspecifiedPROVIDER NUMBER
TXAMB317Medicare Oscar/Certification