Provider Demographics
NPI:1487910360
Name:MERCY HEALTH MEDICAL TRANSPORTATION LLC
Entity type:Organization
Organization Name:MERCY HEALTH MEDICAL TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:R
Authorized Official - Last Name:BEAUCHEMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-304-6023
Mailing Address - Street 1:6510 CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-2101
Mailing Address - Country:US
Mailing Address - Phone:513-330-5469
Mailing Address - Fax:
Practice Address - Street 1:6510 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-2101
Practice Address - Country:US
Practice Address - Phone:513-330-5469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-05
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3416L0300X, 343900000X, 341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)