MEDICARE: ALLSTATE EMS AMBULANCE SERVICE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance	101224	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275624967
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLSTATE EMS AMBULANCE SERVICE INC

Provider Business Mailing Address
First Line	:	4207 GARDENDALE ST
Second Line	:	101-B
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3182
Country	:	US
Telephone Number	:	713-691-7311
Fax Number	:	713-691-7313

Provider Business Practice Location Address
First Line	:	6365 MILLERVIEW DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77091-3358
Country	:	US
Telephone Number	:	713-691-7311
Fax Number	:	713-691-7313

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DERRICK HUNTER
Credential	:
Telephone Number	:	713-691-7311

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	01/23/2014

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