MEDICARE: ABUNDANT AMBULANCE LLC

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	101342	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AMB902	OTHER	TX	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093812018
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABUNDANT AMBULANCE LLC

Provider Business Mailing Address
First Line	:	PO BOX 300088
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77230-0088
Country	:	US
Telephone Number	:	713-252-0123
Fax Number	:

Provider Business Practice Location Address
First Line	:	8034 CULEBRA RD
Second Line	:	102
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-1882
Country	:	US
Telephone Number	:	210-444-9039
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ROSALYN SMART
Credential	:
Telephone Number	:	713-252-0123

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/16/2010

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Directions to “ABUNDANT AMBULANCE LLC ” Practice Location

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