Provider Demographics
NPI:1053373407
Name:MERCY FLIGHT CENTRAL INC
Entity type:Organization
Organization Name:MERCY FLIGHT CENTRAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KLEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-396-0584
Mailing Address - Street 1:PO BOX 535
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-0535
Mailing Address - Country:US
Mailing Address - Phone:315-635-1789
Mailing Address - Fax:315-635-3289
Practice Address - Street 1:2420 BRICKYARD RD
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-7968
Practice Address - Country:US
Practice Address - Phone:585-396-0584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY105053416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
950881OtherMVP
NY01449903Medicaid
P0100637MFOtherBCBS OF ROCHESTER
258220300OtherUS DEPT OF LABOR OWCP
9602223OtherGHI
A3511959OtherOXFORD HEALTH
950881OtherMVP
590008101Medicare ID - Type UnspecifiedRR