MEDICARE: MERCY AMBULANCE SERVICE, 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	341600000X	Ambulance	1796-1391	CA

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

General Provider Information

NPI Number	:	1225037849
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY AMBULANCE SERVICE, INC.

Provider Business Mailing Address
First Line	:	10909 ALMOND AVE
Second Line	:
City	:	FONTANA
State	:	CA
Zip	:	92337-7104
Country	:	US
Telephone Number	:	877-486-3729
Fax Number	:	562-927-8929

Provider Business Practice Location Address
First Line	:	8218 GARFIELD AVE
Second Line	:
City	:	BELL GARDENS
State	:	CA
Zip	:	90201-6212
Country	:	US
Telephone Number	:	877-486-3729
Fax Number	:	562-927-8929

Authorized Official
Title or Position	:	CEO
Name	:	MR. CRAIG E ESTERLY
Credential	:
Telephone Number	:	877-486-3729

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	08/22/2020

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