MEDICARE: ADVANCE MERCY TRASPORTATION 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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1780415570
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCE MERCY TRASPORTATION INC

Provider Business Mailing Address
First Line	:	114 DEL PRADO BLVD S
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-1724
Country	:	US
Telephone Number	:	239-233-1717
Fax Number	:

Provider Business Practice Location Address
First Line	:	114 DEL PRADO BLVD S
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-1724
Country	:	US
Telephone Number	:	239-233-1717
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANIA T RODRIGUEZ
Credential	:
Telephone Number	:	239-233-1717

Provider Enumeration Date	:	08/12/2024
Last Update Date	:	08/12/2024

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