Provider Demographics
NPI:1003979444
Name:HAVRE DE GRACE AMBULANCE CORPS INC
Entity Type:Organization
Organization Name:HAVRE DE GRACE AMBULANCE CORPS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HEMLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-939-6658
Mailing Address - Street 1:PO BOX 465
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-0465
Mailing Address - Country:US
Mailing Address - Phone:410-939-6658
Mailing Address - Fax:
Practice Address - Street 1:1601 LEVEL RD
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-1727
Practice Address - Country:US
Practice Address - Phone:410-939-6658
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR739OtherFEDERAL BLUE SHIELD
MD099401000OtherAMERIHEALTH
MD485200100Medicaid
MDAM11OtherCAREFIRST BLUE CROSS
MD98767OtherHEALTH AMERICA
MDR739OtherFEDERAL BLUE SHIELD
590010229Medicare PIN