Basic Information
| Provider Information | |||||||||
| NPI: | 1851375562 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MERCY REGIONAL EMERGENCY MEDICAL SYSTEM LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9150 | ||||||||
| Address2: | |||||||||
| City: | PADUCAH | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420029150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707448413 | ||||||||
| FaxNumber: | 2707448642 | ||||||||
| Practice Location | |||||||||
| Address1: | 3551 COLEMAN RD | ||||||||
| Address2: | |||||||||
| City: | PADUCAH | ||||||||
| State: | KY | ||||||||
| PostalCode: | 42001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2704436529 | ||||||||
| FaxNumber: | 2704449128 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2005 | ||||||||
| LastUpdateDate: | 04/05/2021 | ||||||||
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| AuthorizedOfficialLastName: | JEFFREY | ||||||||
| AuthorizedOfficialFirstName: | JEREMY | ||||||||
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| AuthorizedOfficialTitleorPosition: | EMS DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2704436529 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | 1011 | KY | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 55073050 | 05 | KY | MEDICAID | 56007172 | 05 | KY | MEDICAID | 1519184 | 05 | TN | MEDICAID |