Provider Demographics
NPI:1164422143
Name:SAN ANTONIO EXTENDED MEDICAL CARE, INC.
Entity Type:Organization
Organization Name:SAN ANTONIO EXTENDED MEDICAL CARE, INC.
Other - Org Name:MED MART - SAN ANTONIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-697-9933
Mailing Address - Street 1:21195 IH 10 W
Mailing Address - Street 2:SUITE 1101
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-1674
Mailing Address - Country:US
Mailing Address - Phone:210-697-9933
Mailing Address - Fax:210-697-8753
Practice Address - Street 1:21195 IH 10 W
Practice Address - Street 2:SUITE 1101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-1674
Practice Address - Country:US
Practice Address - Phone:210-697-9933
Practice Address - Fax:210-697-8753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-30
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X, 332BP3500X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0156986-01Medicaid
TX1023589OtherACM PRIMARY & SECONDARY
TX508280OtherBCBS
TX0867822-01Medicaid
TX0867822-01Medicaid