Provider Demographics
NPI:1992980411
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/ OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:B
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:2008-01-03
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121101341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX187748201Medicaid
TXGTPA1OtherGTPA
TXAMB697OtherBC/BS
TXAMB543Medicare PIN