Provider Demographics
NPI:1376576181
Name:MERCY AMBULANCE OF EVANSVILLE INC
Entity Type:Organization
Organization Name:MERCY AMBULANCE OF EVANSVILLE INC
Other - Org Name:LIFEGUARD AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP OF REVENUE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-703-2294
Mailing Address - Street 1:PO BOX 100217
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-0217
Mailing Address - Country:US
Mailing Address - Phone:833-703-2294
Mailing Address - Fax:
Practice Address - Street 1:950 E VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47711-0000
Practice Address - Country:US
Practice Address - Phone:812-421-6500
Practice Address - Fax:812-428-2621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100311060Medicaid
KY7100311200Medicaid
590008472OtherRAILROAD
ININ0000D100166OtherSECTION 1011
1376576181OtherTRICARE EAST
IN300034909Medicaid
IN985570Medicare PIN