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General NPI Number Information
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NPI Number | 1073094025
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Entity Type | Organization
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Legal Business Name | ANGEL OF MERCY TRANSPORTATION
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Dates
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Enumeration Date | 08/28/2018
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Last Update Date | 08/28/2018
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Provider Practice Location Address
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Address Line | 16824 STATE HIGHWAY 7 E
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City | KENNARD
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State | TX
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Zip | 75847-7584
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Country | US
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Telephone | 936-655-2791
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 182
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City | KENNARD
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State | TX
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Zip | 75847-0182
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Country | US
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Telephone | 936-240-5964
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Fax |
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Authorized Official
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Title or Position | TRANSPORT DRIVER
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Name | MR. RAY BOSTON
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Credential |
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Telephone | 936-240-5964
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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