Healthcare Provider Details

I. General information

NPI: 1396570909
Provider Name (Legal Business Name): MERCY MEDICAL TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 09/07/2024
Certification Date: 09/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 ROUTE 38 STE 355F
CHERRY HILL NJ
08002-2976
US

IV. Provider business mailing address

4000 PRESIDENTIAL BLVD APT 517
PHILADELPHIA PA
19131-1717
US

V. Phone/Fax

Practice location:
  • Phone: 917-564-4567
  • Fax:
Mailing address:
  • Phone: 917-564-4567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. SANDY ALBERTO
Title or Position: CEO
Credential: EMT-B
Phone: 917-564-4567