Provider Demographics
NPI:1003987108
Name:MAURICE SHANER II
Entity Type:Organization
Organization Name:MAURICE SHANER II
Other - Org Name:AMB -TRANS AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:E
Authorized Official - Last Name:SHANER
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:210-734-3402
Mailing Address - Street 1:538 W WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-3345
Mailing Address - Country:US
Mailing Address - Phone:210-734-3402
Mailing Address - Fax:
Practice Address - Street 1:538 W WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-3345
Practice Address - Country:US
Practice Address - Phone:210-734-3402
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-11
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0150943416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000741101Medicaid
TXAMB552OtherBLUE CROSS BLUE SHIELD
TX=========OtherCOMMERCIAL INS
AMB109Medicare UPIN