Provider Demographics
NPI:1063673044
Name:MERCY TANSPORTATION LLC
Entity Type:Organization
Organization Name:MERCY TANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHOMMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-482-6125
Mailing Address - Street 1:1957 BELLOMY ST APT 4
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-5747
Mailing Address - Country:US
Mailing Address - Phone:408-482-6125
Mailing Address - Fax:
Practice Address - Street 1:1957 BELLOMY ST APT 4
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-5747
Practice Address - Country:US
Practice Address - Phone:408-482-6125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3LST995343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)