Provider Demographics
NPI:1255448908
Name:MEDCARE AMBULANCE INC
Entity type:Organization
Organization Name:MEDCARE AMBULANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:MITCHEL
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:SHANER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-337-7772
Mailing Address - Street 1:PO BOX 625
Mailing Address - Street 2:
Mailing Address - City:ADKINS
Mailing Address - State:TX
Mailing Address - Zip Code:78101-0625
Mailing Address - Country:US
Mailing Address - Phone:210-337-7772
Mailing Address - Fax:210-337-9282
Practice Address - Street 1:3503 S WW WHITE RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78222-5017
Practice Address - Country:US
Practice Address - Phone:210-337-7772
Practice Address - Fax:210-337-9282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0151093416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179039601Medicaid
TXAMB814OtherBLUECROSS BLUESHIELD TX
TXAMB814OtherBLUE CROSS BLUE SHIELD
P00718077OtherPALMETTO RAILROAD MEDICARE
TX179039601Medicaid