Provider Demographics
NPI:1346372562
Name:MIDATLANTIC MEDEVAC LLC
Entity Type:Organization
Organization Name:MIDATLANTIC MEDEVAC LLC
Other - Org Name:MIDATLANTIC MEDEVAC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SPATZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-762-4713
Mailing Address - Street 1:PO BOX 822356
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182
Mailing Address - Country:US
Mailing Address - Phone:215-762-4713
Mailing Address - Fax:215-762-1803
Practice Address - Street 1:230 NORTH BROAD STREET
Practice Address - Street 2:SUITE 487
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-1192
Practice Address - Country:US
Practice Address - Phone:215-762-4713
Practice Address - Fax:215-762-1803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA021343416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1268051OtherAETNA
PA20051037OtherAMERIHEALTH MERCY
PA0254302000OtherKEYSTONE HEALTH PLAN EAST
PA0254302000OtherBCBS
PA30032593OtherKEYSTONE MERCY HEALTH PLA
PA0254302000OtherKEYSTONE 65
PA1126864OtherHORIZON NJ HEALTH
PA91002039100OtherAMERICHOICE
PA0254302000OtherINDEPENDENCE BLUE CROSS
PA1011339OtherAMERIHEALTH
PA=========OtherTRICARE