Provider Demographics
NPI:1043503428
Name:TRISTATE AMBULANCE INC
Entity Type:Organization
Organization Name:TRISTATE AMBULANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEON
Authorized Official - Middle Name:
Authorized Official - Last Name:BELOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-334-6269
Mailing Address - Street 1:72 BELLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FEASTERVILLE TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-7215
Mailing Address - Country:US
Mailing Address - Phone:267-334-6269
Mailing Address - Fax:888-316-5731
Practice Address - Street 1:12301 MCNULTY RD
Practice Address - Street 2:UNIT B
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19154-1000
Practice Address - Country:US
Practice Address - Phone:267-334-6269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA110243416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport