Provider Demographics
NPI:1154297554
Name:MERCY MEDICAL TRANSPORT LLC
Entity type:Organization
Organization Name:MERCY MEDICAL TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBERTO FAJARDO
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:917-564-4567
Mailing Address - Street 1:267 BROADWAY APT 2F
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-6237
Mailing Address - Country:US
Mailing Address - Phone:917-564-4567
Mailing Address - Fax:
Practice Address - Street 1:267 BROADWAY APT 2F
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-6237
Practice Address - Country:US
Practice Address - Phone:917-564-4567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-13
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)