Healthcare Provider Details

I. General information

NPI: 1184070070
Provider Name (Legal Business Name): ST JUDE SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2016
Last Update Date: 05/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 FREDERICKSBURG RD STE 110
SAN ANTONIO TX
78201-5552
US

IV. Provider business mailing address

1103 FREDERICKSBURG RD STE 110
SAN ANTONIO TX
78201-5552
US

V. Phone/Fax

Practice location:
  • Phone: 210-592-3084
  • Fax:
Mailing address:
  • Phone: 210-592-3084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: ROBERT CARRION
Title or Position: OWNER
Credential:
Phone: 210-592-3084