Provider Demographics
NPI:1699554725
Name:GRACEY & MERCY MEDICAL TRANSPORT LLC
Entity type:Organization
Organization Name:GRACEY & MERCY MEDICAL TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICHOLA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-253-5768
Mailing Address - Street 1:126 NE RIDGEVIEW COURT
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:FL
Mailing Address - Zip Code:32340-6165
Mailing Address - Country:US
Mailing Address - Phone:850-253-5768
Mailing Address - Fax:
Practice Address - Street 1:126 NE RIDGEVIEW COURT
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:FL
Practice Address - Zip Code:32340-6165
Practice Address - Country:US
Practice Address - Phone:850-253-5768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle