MEDICARE: MERCY MEDICAL TRANSPORTATION 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	343900000X	Non-emergency Medical Transport (VAN)	259475	OH

General Provider Information

NPI Number	:	1568805539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY MEDICAL TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	1395 E DUBLIN GRANVILLE RD
Second Line	:	STE: 111
City	:	COLUMBUS
State	:	OH
Zip	:	43229-3313
Country	:	US
Telephone Number	:	614-946-5474
Fax Number	:

Provider Business Practice Location Address
First Line	:	1395 E DUBLIN GRANVILLE RD
Second Line	:	STE: 111
City	:	COLUMBUS
State	:	OH
Zip	:	43229-3313
Country	:	US
Telephone Number	:	614-946-5474
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MOHAMMED M AHMED
Credential	:
Telephone Number	:	614-946-5474

Provider Enumeration Date	:	04/09/2013
Last Update Date	:	04/09/2013

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