=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730304700
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLSTATE AMBULANCE SERVICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2007
-----------------------------------------------------
Last Update Date | 04/16/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3301 CENTURY DR STE B
-----------------------------------------------------
City | ROWLETT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75088-7555
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 975-475-3358
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3301 CENTURY DR STE B
-----------------------------------------------------
City | ROWLETT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75088-7555
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 975-475-3358
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | STELLA HARISTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 972-475-3358
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 800113
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------