Medicaid360, Inc.

Primary specialty

ContractorTaxonomy code 171W00000X

Legal business name

MEDICAID360, INC.

Practice address

626 Mesa RDG
San Antonio, TX 78258-4815

Phone

(210) 863-1600

NPI assigned

Apr 21, 2009

Last updated

Apr 21, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Teresa Harris

Title

President

Phone

(210) 863-1600

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1240272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1240272000000",
    "number": "1790929743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "626 MESA RDG",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782584815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "626 MESA RDG",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782584815",
            "telephone_number": "210-863-1600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAID360, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-21",
        "last_updated": "2009-04-21",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "TERESA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "210-863-1600"
    },
    "taxonomies": [
        {
            "code": "171W00000X",
            "taxonomy_group": "",
            "desc": "Contractor",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BILLING",
            "identifier": "263656705",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Medexpress Primary Care Texas, P.a. (The Well - San Antonio)
• Medfund LLC (Horizon MRI of San Antonio North LLC)
• Medfusion Pharmacy
• Medi-Ryde, LLC (MediRyde)
• Medi-Tronics
• Medical and Health Physicians of San Antonio PLLC
• Medical Care Innovation, P.C.
• Medical Center Ophthalmology Associates
• Medical Center Ophthalmology Associates
• Medical Center Ophthalmology Associates

• Contractor in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Contractor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.