Provider Demographics
NPI:1477026714
Name:MERCY MEDICAL TRANSPORTATION LLC
Entity Type:Organization
Organization Name:MERCY MEDICAL TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:OGBU
Authorized Official - Middle Name:KALU
Authorized Official - Last Name:OLU
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:978-509-1681
Mailing Address - Street 1:668 WHIPPLE RD
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-2654
Mailing Address - Country:US
Mailing Address - Phone:978-509-1681
Mailing Address - Fax:
Practice Address - Street 1:668 WHIPPLE RD
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-2654
Practice Address - Country:US
Practice Address - Phone:978-509-1681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)