MEDICARE: ST JOHNS REGIONAL

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	101307	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0000AMB676	OTHER	TX	BCBS PROVIDER NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861481616
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST JOHNS REGIONAL

Provider Business Mailing Address
First Line	:	9630 HOLLOCK ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77075-1806
Country	:	US
Telephone Number	:	713-838-2273
Fax Number	:	713-838-7088

Provider Business Practice Location Address
First Line	:	9630 HOLLOCK ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77075-1806
Country	:	US
Telephone Number	:	713-838-2273
Fax Number	:	713-838-7088

Authorized Official
Title or Position	:	MANAGER
Name	:	MS. LISA SILVA
Credential	:
Telephone Number	:	713-838-2273

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	05/07/2008

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Directions to “ST JOHNS REGIONAL ” Practice Location

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