=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770011462
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MERCURY'S MEDICAL TRANSPORT SERVICE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2017
-----------------------------------------------------
Last Update Date | 05/25/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3200 N SAN FERNANDO BLVD STE 28
-----------------------------------------------------
City | BURBANK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91504-2528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-351-9931
-----------------------------------------------------
Fax | 866-888-9370
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3200 N SAN FERNANDO BLVD STE 28
-----------------------------------------------------
City | BURBANK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91504-2528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 819-351-9931
-----------------------------------------------------
Fax | 866-888-9370
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. WILLIAM ANTHONY STEINER II
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 918-351-9931
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------