Provider Demographics
NPI:1821683160
Name:EWA NON EMERGENCY MEDICAL TRANSPORT AND COURIER SERVICE LLC
Entity Type:Organization
Organization Name:EWA NON EMERGENCY MEDICAL TRANSPORT AND COURIER SERVICE LLC
Other - Org Name:EWA NON EMERGENCY MEDICAL TRANSPORT AND COURIER SERVICE LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLYDE
Authorized Official - Middle Name:GANTRY
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-507-2522
Mailing Address - Street 1:7803 KINGS SPG
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-6068
Mailing Address - Country:US
Mailing Address - Phone:210-889-6973
Mailing Address - Fax:
Practice Address - Street 1:7803 KINGS SPG
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-6068
Practice Address - Country:US
Practice Address - Phone:210-996-6370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-09
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No3416L0300XTransportation ServicesAmbulanceLand Transport
No344600000XTransportation ServicesTaxi
No347C00000XTransportation ServicesPrivate Vehicle