Provider Demographics
NPI:1407156797
Name:PROMED AMBULANCE, INC
Entity Type:Organization
Organization Name:PROMED AMBULANCE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:G
Authorized Official - Last Name:KOPITKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-792-6892
Mailing Address - Street 1:9363 JAMISON AVE
Mailing Address - Street 2:UNIT A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-4278
Mailing Address - Country:US
Mailing Address - Phone:215-792-6892
Mailing Address - Fax:215-774-1347
Practice Address - Street 1:9363 JAMISON AVE
Practice Address - Street 2:UNIT A
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-4278
Practice Address - Country:US
Practice Address - Phone:215-792-6892
Practice Address - Fax:215-774-1347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-02
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport