Provider Demographics
NPI:1184779225
Name:MERCY MEDICAL TRANSPORTATION, INC.
Entity type:Organization
Organization Name:MERCY MEDICAL TRANSPORTATION, INC.
Other - Org Name:<UNAVAIL>
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:
Authorized Official - Credentials:CEO
Authorized Official - Phone:800-456-7142
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:209-742-5286
Mailing Address - Fax:209-966-4901
Practice Address - Street 1:1230 ALDERWOOD AVE
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94089-2201
Practice Address - Country:US
Practice Address - Phone:510-614-1423
Practice Address - Fax:510-614-1420
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY MEDICAL TRANSPORTATION, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1953416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ28542ZMedicare ID - Type UnspecifiedPROVIDER NUMBER