Provider Demographics
NPI:1295720324
Name:ALL TEXAS AMBULANCE, INC.
Entity type:Organization
Organization Name:ALL TEXAS AMBULANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:TILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-244-9992
Mailing Address - Street 1:5645 HILLCROFT ST
Mailing Address - Street 2:801
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-2296
Mailing Address - Country:US
Mailing Address - Phone:713-244-9992
Mailing Address - Fax:713-224-9975
Practice Address - Street 1:5645 HILLCROFT ST
Practice Address - Street 2:801
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-2296
Practice Address - Country:US
Practice Address - Phone:713-244-9992
Practice Address - Fax:713-224-9975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-14
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168386401Medicaid
TX168386401Medicaid
TXAMB393Medicare PIN