Provider Demographics
NPI:1457497026
Name:MERCY MEDICAL TRANSPORTATION INC
Entity Type:Organization
Organization Name:MERCY MEDICAL TRANSPORTATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:FRED
Authorized Official - Last Name:ROESCH
Authorized Official - Suffix:I
Authorized Official - Credentials:CEO
Authorized Official - Phone:209-966-5762
Mailing Address - Street 1:PO BOX 5004
Mailing Address - Street 2:
Mailing Address - City:MARIPOSA
Mailing Address - State:CA
Mailing Address - Zip Code:95338-5004
Mailing Address - Country:US
Mailing Address - Phone:209-966-5762
Mailing Address - Fax:209-966-4901
Practice Address - Street 1:5081 HWY 140
Practice Address - Street 2:
Practice Address - City:MARIPOSA
Practice Address - State:CA
Practice Address - Zip Code:95338
Practice Address - Country:US
Practice Address - Phone:209-966-2178
Practice Address - Fax:209-966-4901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1953416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTE00742FMedicaid
CAMTE00742FMedicaid