Healthcare Provider Details

I. General information

NPI: 1376647412
Provider Name (Legal Business Name): MERCURY AMBULANCE SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 GERNERT CT
LOUISVILLE KY
40217-1027
US

IV. Provider business mailing address

PO BOX 100217
ATLANTA GA
30384-0217
US

V. Phone/Fax

Practice location:
  • Phone: 502-636-0414
  • Fax: 502-214-7431
Mailing address:
  • Phone: 800-913-9106
  • Fax: 330-384-4019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number1107
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number1594
License Number StateKY

VIII. Authorized Official

Name: MR. ERIC THOMAS
Title or Position: SVP OF REVENUE MANAGEMENT
Credential:
Phone: 833-703-2294