Provider Demographics
NPI:1720028442
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 INTERSTATE HIGHWAY 10 WEST
Mailing Address - Street 2:SUTIE 1101
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 1:416 SHILOH DR STE C4
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-6755
Practice Address - Country:US
Practice Address - Phone:956-753-2211
Practice Address - Fax:956-753-2266
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
TX00796980332B00000X
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
TX17494902Medicaid
TX531700OtherBLUE CROSS BLUE SHIELD
TX174949101Medicaid
TX1025666OtherACM
TX1025666OtherACM