Provider Demographics
NPI:1922026814
Name:ST FLORIAN AMBULANCE LLC
Entity Type:Organization
Organization Name:ST FLORIAN AMBULANCE LLC
Other - Org Name:ST FLORIAN AMBULANCE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-927-3901
Mailing Address - Street 1:6999 W LITTLE YORK RD STE M
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77040-4800
Mailing Address - Country:US
Mailing Address - Phone:713-934-9411
Mailing Address - Fax:713-934-9577
Practice Address - Street 1:6999 W LITTLE YORK RD STE M
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77040-4800
Practice Address - Country:US
Practice Address - Phone:713-934-9411
Practice Address - Fax:713-934-9577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAMB538Medicare PIN