Provider Demographics
NPI:1134407687
Name:ST JUDE AMBULANCE LLC
Entity type:Organization
Organization Name:ST JUDE AMBULANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NGUYEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-538-3319
Mailing Address - Street 1:PO BOX 17953
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77496-7953
Mailing Address - Country:US
Mailing Address - Phone:713-538-3319
Mailing Address - Fax:713-255-8899
Practice Address - Street 1:11500 NORTHWEST FWY
Practice Address - Street 2:SUITE 265
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-6537
Practice Address - Country:US
Practice Address - Phone:713-538-3319
Practice Address - Fax:713-255-8899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-02
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10006353416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport