MEDICARE: CITY OF SHAVANO PARK

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	015108	TX
2	341600000X	Ambulance

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	AMB418	OTHER	TX	MEDICARE PTAN

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	:	1336139633
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF SHAVANO PARK

Provider Business Mailing Address
First Line	:	15604 NW MILITARY HWY
Second Line	:
City	:	SHAVANO PARK
State	:	TX
Zip	:	78231-1537
Country	:	US
Telephone Number	:	210-492-1111
Fax Number	:	210-492-5884

Provider Business Practice Location Address
First Line	:	15604 NW MILITARY HWY
Second Line	:
City	:	SHAVANO PARK
State	:	TX
Zip	:	78231-1537
Country	:	US
Telephone Number	:	210-492-1111
Fax Number	:	210-492-5884

Authorized Official
Title or Position	:	FINANCE DIRECTOR
Name	:	BRENDA MOREY
Credential	:
Telephone Number	:	210-477-0960

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	09/28/2023

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Directions to “CITY OF SHAVANO PARK ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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