MEDICARE: CITY OF PRESIDIO

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	189003	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	590004836	OTHER	TX	RAILROAD MEDICARE

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	:	1851582316
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF PRESIDIO

Provider Business Mailing Address
First Line	:	507 W O'RIELEY ST
Second Line	:
City	:	PRESIDIO
State	:	TX
Zip	:	79845
Country	:	US
Telephone Number	:	432-229-3517
Fax Number	:

Provider Business Practice Location Address
First Line	:	507 W O'RIELEY ST
Second Line	:
City	:	PRESIDIO
State	:	TX
Zip	:	79845
Country	:	US
Telephone Number	:	432-229-3517
Fax Number	:

Authorized Official
Title or Position	:	CITY OF PRESIDIO ADMINISTRATOR
Name	:	MARCO A BAEZA
Credential	:
Telephone Number	:	432-229-3517

Provider Enumeration Date	:	08/08/2007
Last Update Date	:	11/24/2015

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1942416631 — AMC PRESIDIO CLINIC
Practice Location Address:

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Directions to “CITY OF PRESIDIO ” Practice Location

Language	Start Address	Practice Location

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