MEDICARE: PHAROS

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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1982102729
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHAROS

Provider Business Mailing Address
First Line	:	4950 WOODSTONE DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-1186
Country	:	US
Telephone Number	:	210-995-4193
Fax Number	:

Provider Business Practice Location Address
First Line	:	4950 WOODSTONE DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-1186
Country	:	US
Telephone Number	:	210-995-4193
Fax Number	:

Authorized Official
Title or Position	:	MANGER
Name	:	OMAR YOUSSEF
Credential	:
Telephone Number	:	210-995-4193

Provider Enumeration Date	:	01/26/2018
Last Update Date	:	01/26/2018

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Directions to “PHAROS ” Practice Location

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