Provider Demographics
NPI:1851375695
Name:STAT SERVICES OF JASPER COUNTY A, LLP
Entity type:Organization
Organization Name:STAT SERVICES OF JASPER COUNTY A, LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR BILLING - OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-833-3834
Mailing Address - Street 1:PO BOX 552
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77704-0552
Mailing Address - Country:US
Mailing Address - Phone:409-833-3834
Mailing Address - Fax:409-833-2060
Practice Address - Street 1:2418 N WHEELER ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-2115
Practice Address - Country:US
Practice Address - Phone:409-833-3834
Practice Address - Fax:409-833-2060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121101341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXGTPA1OtherSECURE HORIZONS
TX80705OtherGREAT WEST
TXAMB697OtherBLUE CROSS BLUE SHEILD
TXAMB697OtherBLUE CROSS BLUE SHIELD
TXGTPA1OtherTEXAN PLUS
TXGTPA1OtherENCORE ENCORE
TX21160OtherUSFHP
TXGTPA1OtherSELECT CARE OF TX
TXGTPA1OtherSELECT CARE OF TX
TXGTPA1OtherTEXAN PLUS