Healthcare Provider Details

I. General information

NPI: 1679947485
Provider Name (Legal Business Name): MERCEDES CAB COMPANY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2015
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

352 ROUTE 6 3-11
NORTH TRURO MA
02652
US

IV. Provider business mailing address

35 ALDEN ST
PROVINCETOWN MA
02657-1405
US

V. Phone/Fax

Practice location:
  • Phone: 508-487-8333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347B00000X
TaxonomyBus
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number13-RB-624
License Number StateMA

VIII. Authorized Official

Name: MR. RAPHAEL W RICHTER
Title or Position: CEO
Credential:
Phone: 774-722-1422