MEDICARE: MAURICE SHANER II

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	3416L0300X	Land Ambulance	015094	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
2	AMB552	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1003987108
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAURICE SHANER II

Provider Business Mailing Address
First Line	:	538 W WOODLAWN AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-3345
Country	:	US
Telephone Number	:	210-734-3402
Fax Number	:

Provider Business Practice Location Address
First Line	:	538 W WOODLAWN AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-3345
Country	:	US
Telephone Number	:	210-734-3402
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MAURICE E SHANER II
Credential	:
Telephone Number	:	210-734-3402

Provider Enumeration Date	:	11/11/2006
Last Update Date	:	10/27/2020

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Directions to “MAURICE SHANER II ” Practice Location

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