Provider Demographics
NPI:1184070070
Name:ST JUDE SERVICES, INC
Entity type:Organization
Organization Name:ST JUDE SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-592-3084
Mailing Address - Street 1:1103 FREDERICKSBURG RD STE 110
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-5552
Mailing Address - Country:US
Mailing Address - Phone:210-592-3084
Mailing Address - Fax:
Practice Address - Street 1:1103 FREDERICKSBURG RD STE 110
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-5552
Practice Address - Country:US
Practice Address - Phone:210-592-3084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST JUDE SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)