Provider Demographics
NPI:1336139633
Name:CITY OF SHAVANO PARK
Entity Type:Organization
Organization Name:CITY OF SHAVANO PARK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-477-0960
Mailing Address - Street 1:15604 NW MILITARY HWY
Mailing Address - Street 2:
Mailing Address - City:SHAVANO PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1537
Mailing Address - Country:US
Mailing Address - Phone:210-492-1111
Mailing Address - Fax:210-492-5884
Practice Address - Street 1:15604 NW MILITARY HWY
Practice Address - Street 2:
Practice Address - City:SHAVANO PARK
Practice Address - State:TX
Practice Address - Zip Code:78231-1537
Practice Address - Country:US
Practice Address - Phone:210-492-1111
Practice Address - Fax:210-492-5884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
341600000X
TX0151083416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171420601Medicaid
TXAMB418OtherMEDICARE PTAN