MEDICARE: MERCY EMS, LLC

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	800009	TX

General Provider Information

NPI Number	:	1205839230
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY EMS, LLC

Provider Business Mailing Address
First Line	:	15401 ADDISON RD
Second Line	:
City	:	ADDISON
State	:	TX
Zip	:	75001-3282
Country	:	US
Telephone Number	:	972-788-9401
Fax Number	:

Provider Business Practice Location Address
First Line	:	15401 ADDISON RD
Second Line	:
City	:	ADDISON
State	:	TX
Zip	:	75001-3282
Country	:	US
Telephone Number	:	972-788-9401
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. ROBERT WOOD
Credential	:
Telephone Number	:	972-788-9401

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	08/22/2020

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