MEDICARE: MERCY AMBULANCE OF EVANSVILLE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance
2	341600000X	Ambulance

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053954800
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY AMBULANCE OF EVANSVILLE INC

Provider Business Mailing Address
First Line	:	PO BOX 100217
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30384-0217
Country	:	US
Telephone Number	:	800-913-9106
Fax Number	:

Provider Business Practice Location Address
First Line	:	299 ISLAND CREEK RD
Second Line	:
City	:	PIKEVILLE
State	:	KY
Zip	:	41501-9341
Country	:	US
Telephone Number	:	606-432-8100
Fax Number	:

Authorized Official
Title or Position	:	EVP, CHIEF FINANCIAL OFFICER
Name	:	BRIAN SCOTT TIERNEY
Credential	:
Telephone Number	:	833-703-2294

Provider Enumeration Date	:	10/24/2019
Last Update Date	:	03/16/2026

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