Provider Demographics
NPI:1356335806
Name:ALLIANCE AMBULANCE, INC
Entity type:Organization
Organization Name:ALLIANCE AMBULANCE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:EDENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-682-2273
Mailing Address - Street 1:6214 SAXON DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092-6247
Mailing Address - Country:US
Mailing Address - Phone:713-682-2273
Mailing Address - Fax:713-682-5815
Practice Address - Street 1:6214 SAXON DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-6247
Practice Address - Country:US
Practice Address - Phone:713-682-2273
Practice Address - Fax:713-682-5815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101212341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000574601Medicaid
TX4644548OtherAETNA
TX528034Medicare ID - Type Unspecified