Provider Demographics
NPI:1679814453
Name:MRW MEDICAL TRANSPORT, LLC
Entity Type:Organization
Organization Name:MRW MEDICAL TRANSPORT, LLC
Other - Org Name:PREMIER EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICAELA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-834-2559
Mailing Address - Street 1:PO BOX 898
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-0898
Mailing Address - Country:US
Mailing Address - Phone:210-226-1111
Mailing Address - Fax:
Practice Address - Street 1:3700 FREDERICKSBURG RD
Practice Address - Street 2:SUITE 117
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-3269
Practice Address - Country:US
Practice Address - Phone:210-226-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-04
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10008843416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0267885OtherWELLMED
TX326568801Medicaid
TX01973471OtherAMERIGROUP
TX208286OtherSUPERIOR
TX280097Medicare PIN