Provider Demographics
NPI:1952467565
Name:MERCY AMBULANCE
Entity Type:Organization
Organization Name:MERCY AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:
Authorized Official - Last Name:TESLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-202-6106
Mailing Address - Street 1:PO BOX 1988
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-0017
Mailing Address - Country:US
Mailing Address - Phone:617-782-4900
Mailing Address - Fax:
Practice Address - Street 1:20 LINDEN ST
Practice Address - Street 2:
Practice Address - City:ALLSTON
Practice Address - State:MA
Practice Address - Zip Code:02134-1711
Practice Address - Country:US
Practice Address - Phone:617-782-4900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA30473416L0300X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered3416L0300XTransportation ServicesAmbulanceLand Transport
Not Answered343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000000028195OtherBMC HEALTHNET
MA821515OtherTUFTS
MA975066OtherNETWORK HEALTH
MA103059OtherBLUE CROSS BLUE SHIELD
MA1720953Medicaid
MA702478OtherHARVARD PILGRIM HLTHCARE
MA1720953Medicaid
MA975066OtherNETWORK HEALTH