MEDICARE: CALERA, 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	335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier	R21636	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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	630001196	OTHER	TX	PALMETTO RR
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578545000
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALERA, INC.

Provider Business Mailing Address
First Line	:	1421 SIOUX RD.
Second Line	:
City	:	ALAMO
State	:	TX
Zip	:	78516
Country	:	US
Telephone Number	:	956-783-9779
Fax Number	:	956-783-7437

Provider Business Practice Location Address
First Line	:	1421 SIOUX RD.
Second Line	:
City	:	ALAMO
State	:	TX
Zip	:	78516
Country	:	US
Telephone Number	:	956-783-9779
Fax Number	:	956-783-7437

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	MR. RAUL CALERA
Credential	:	R.T.
Telephone Number	:	956-783-9779

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	06/20/2008

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Directions to “CALERA, INC. ” Practice Location

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