Provider Demographics
NPI:1245200419
Name:MERCY AMBULANCE SERVICE, INC.
Entity Type:Organization
Organization Name:MERCY AMBULANCE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CHRISTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:BSBA
Authorized Official - Phone:502-368-6551
Mailing Address - Street 1:468 HURON AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40209-1626
Mailing Address - Country:US
Mailing Address - Phone:502-368-6551
Mailing Address - Fax:502-368-8500
Practice Address - Street 1:468 HURON AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40209-1626
Practice Address - Country:US
Practice Address - Phone:502-368-6551
Practice Address - Fax:502-368-8500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1109341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1056316OtherPASSPORT HEALTH PLAN
KY55056097Medicaid
KY000000069978OtherBLUE CROSS/BLUE SHIELD
KY56004401Medicaid
KY56004401Medicaid
KY8011101Medicare ID - Type Unspecified