1659302149 NPI number — PHILADELPHIA AMBULANCE

Table of content: (NPI 1659302149)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659302149 NPI number — PHILADELPHIA AMBULANCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHILADELPHIA AMBULANCE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AMERIHEART AMBULANCE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659302149
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13440 DAMAR DR
Provider Second Line Business Mailing Address:
SUITE G
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19116-1817
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-676-7200
Provider Business Mailing Address Fax Number:
215-676-2806

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13440 DAMAR DR
Provider Second Line Business Practice Location Address:
SUITE G
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19116-1817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-676-7200
Provider Business Practice Location Address Fax Number:
215-676-2806
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEVENZON
Authorized Official First Name:
BORIS
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
215-676-7200

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  03190 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0058238 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0002049000 . This is a "KEYSTONE HEALTH PLAN EAST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P00060300 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0002049000 . This is a "AMERIHEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0019703770001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2049 . This is a "INDEP. BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 710200PA19116 . This is a "BC/BS OF MICHIGAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3427265 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30014238 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 34218 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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