Provider Demographics
NPI:1730477019
Name:MERCY AIR SERVICE INC
Entity Type:Organization
Organization Name:MERCY AIR SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAO
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:J
Authorized Official - Last Name:KECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-499-9495
Mailing Address - Street 1:PO BOX 84621
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-5921
Mailing Address - Country:US
Mailing Address - Phone:909-915-2303
Mailing Address - Fax:402-952-2411
Practice Address - Street 1:1035 S CAWSTON AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92545
Practice Address - Country:US
Practice Address - Phone:800-499-9495
Practice Address - Fax:402-952-2411
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROCKY MOUNTAIN HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-20
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2029503416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ18514ZMedicare PIN