Provider Demographics
NPI:1164790168
Name:GOSPEL AMBULANCE, INC.
Entity Type:Organization
Organization Name:GOSPEL AMBULANCE, INC.
Other - Org Name:GOSPEL AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GERTSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-420-4110
Mailing Address - Street 1:2179 BENNETT RD
Mailing Address - Street 2:UNIT A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-3021
Mailing Address - Country:US
Mailing Address - Phone:908-420-4110
Mailing Address - Fax:215-464-5666
Practice Address - Street 1:2179 BENNETT RD
Practice Address - Street 2:UNIT A
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-3021
Practice Address - Country:US
Practice Address - Phone:908-420-4110
Practice Address - Fax:215-464-5666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport