MEDICARE: MEDICAL RELIANCE AMBULANCE SERVICE

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	015107	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AMB625	OTHER	TX	BCBS TEXAS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851395404
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL RELIANCE AMBULANCE SERVICE

Provider Business Mailing Address
First Line	:	7231 POSS RD
Second Line	:
City	:	LEON VALLEY
State	:	TX
Zip	:	78240-3135
Country	:	US
Telephone Number	:	800-617-1213
Fax Number	:	800-617-1214

Provider Business Practice Location Address
First Line	:	7231 POSS RD
Second Line	:
City	:	LEON VALLEY
State	:	TX
Zip	:	78240-3135
Country	:	US
Telephone Number	:	800-617-1213
Fax Number	:	800-617-1214

Authorized Official
Title or Position	:	OWNER
Name	:	EDGAR MARTINEZ
Credential	:	EMT
Telephone Number	:	800-617-1213

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	08/22/2020

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