Healthcare Provider Details

I. General information

NPI: 1699554725
Provider Name (Legal Business Name): GRACEY & MERCY MEDICAL TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2023
Last Update Date: 09/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 NE RIDGEVIEW COURT
MADISON FL
32340-6165
US

IV. Provider business mailing address

126 NE RIDGEVIEW COURT
MADISON FL
32340-6165
US

V. Phone/Fax

Practice location:
  • Phone: 850-253-5768
  • Fax:
Mailing address:
  • Phone: 850-253-5768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MRS. NICHOLA MICHELLE ALEXANDER
Title or Position: OPERATOR/OWNER
Credential:
Phone: 850-253-5768