Provider Demographics
NPI:1336305531
Name:MERCYLIFE AMBULANCE INC.
Entity Type:Organization
Organization Name:MERCYLIFE AMBULANCE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KHRIPKOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-971-3765
Mailing Address - Street 1:309 PHILMONT AVE
Mailing Address - Street 2:
Mailing Address - City:FEASTERVILLE TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-6406
Mailing Address - Country:US
Mailing Address - Phone:215-355-4458
Mailing Address - Fax:
Practice Address - Street 1:309 PHILMONT AVE
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-6406
Practice Address - Country:US
Practice Address - Phone:215-355-4458
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-06
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA080113416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport