1700885548 NPI number — MERCY AIR SERVICE, INC

Table of content: (NPI 1700885548)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700885548 NPI number — MERCY AIR SERVICE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY AIR SERVICE, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700885548
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 84621
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98124-5921
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-499-9495
Provider Business Mailing Address Fax Number:
909-890-9895

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13000 LAS VEGAS BLVD S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-499-9495
Provider Business Practice Location Address Fax Number:
909-890-9895
Provider Enumeration Date:
07/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KECK
Authorized Official First Name:
SHARON
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CAO
Authorized Official Telephone Number:
800-499-9495

Provider Taxonomy Codes

  • Taxonomy code: 3416A0800X , with the licence number:  202950 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416A0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 114979400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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