Provider Demographics
NPI:1518907237
Name:SAN ANTONIO EXTENDED MEDICAL CARE, INC.
Entity Type:Organization
Organization Name:SAN ANTONIO EXTENDED MEDICAL CARE, INC.
Other - Org Name:MED MART
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 W INTERSTATE 10 STE 1101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-1675
Mailing Address - Country:US
Mailing Address - Phone:210-697-9933
Mailing Address - Fax:210-697-8753
Practice Address - Street 1:1080 CROWN RIDGE BLVD STE 1
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-3496
Practice Address - Country:US
Practice Address - Phone:830-757-4416
Practice Address - Fax:830-757-5550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X, 332BP3500X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173462601Medicaid
TX1025668OtherACM
TX173462602Medicaid
TX532247OtherBLUE CROSS BLUE SHIELD
TX532247OtherBLUE CROSS BLUE SHIELD