1912258062 NPI number — MERCY MEDICAL RESPONSE

Table of content: (NPI 1912258062)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912258062 NPI number — MERCY MEDICAL RESPONSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY MEDICAL RESPONSE
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:
EVER READY MEDICAL RESPONSE
Provider Other Organization Name Type Code:
3
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:
1912258062
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
553 E JERSEY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELIZABETH
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07206-1225
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-368-7482
Provider Business Mailing Address Fax Number:
908-333-5712

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
553 E JERSEY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETH
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07206-1225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-368-7482
Provider Business Practice Location Address Fax Number:
908-333-5712
Provider Enumeration Date:
09/28/2012

Additional Information

Authorized Official

Authorized Official Last Name:
ALKHULANI
Authorized Official First Name:
MUHAMMAD
Authorized Official Middle Name:
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
908-368-7482

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  2012044 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 343900000X , with the licence number: 2012044 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2024 www.npivalidator.com