Provider Demographics
NPI:1376647412
Name:MERCURY AMBULANCE SERVICE INC
Entity Type:Organization
Organization Name:MERCURY AMBULANCE SERVICE INC
Other - Org Name:AMERICAN MEDICAL RESPONSE - LOUISVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP OF REVENUE MANAGEMENT
Authorized Official - Prefix:MR
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:800-913-9106
Mailing Address - Fax:330-384-4019
Practice Address - Street 1:421 GERNERT CT
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1027
Practice Address - Country:US
Practice Address - Phone:502-636-0414
Practice Address - Fax:502-214-7431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
341600000X
KY11073416L0300X
KY15943416L0300X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY55034045Medicaid
KY56004393Medicaid
IN200985180AMedicaid
KY55034045Medicaid
KY56004393Medicaid
KY7100192560Medicaid
IN200985180AMedicaid