MEDICARE: HIGH ISLAND MERCY CORPS INC

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		TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	590014682	OTHER		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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285602656
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIGH ISLAND MERCY CORPS INC

Provider Business Mailing Address
First Line	:	PO BOX 691363
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77269-1363
Country	:	US
Telephone Number	:	281-397-0397
Fax Number	:	281-397-6934

Provider Business Practice Location Address
First Line	:	2144 7TH STREET
Second Line	:
City	:	HIGH ISLAND
State	:	TX
Zip	:	77623
Country	:	US
Telephone Number	:	409-286-5811
Fax Number	:	409-286-5424

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	ROBERT L ISAACKS JR.
Credential	:
Telephone Number	:	409-286-5811

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	10/10/2011

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Directions to “HIGH ISLAND MERCY CORPS INC ” Practice Location

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