Provider Demographics
NPI:1093988784
Name:TAC MED INC.
Entity Type:Organization
Organization Name:TAC MED INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:CANTU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-882-4290
Mailing Address - Street 1:PO BOX 1646
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78573-0029
Mailing Address - Country:US
Mailing Address - Phone:361-882-4290
Mailing Address - Fax:361-882-4097
Practice Address - Street 1:5315 EVERHART RD
Practice Address - Street 2:SUITE 8
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4865
Practice Address - Country:US
Practice Address - Phone:361-882-4290
Practice Address - Fax:361-882-4097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10001173416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AMB967OtherBLUE CROSS BLUE SHIELD
TX1947616Medicaid