Provider Demographics
NPI:1417214859
Name:CAPITAL CARE AMBULANCE INC.
Entity Type:Organization
Organization Name:CAPITAL CARE AMBULANCE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KONSTANTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TETELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-902-3060
Mailing Address - Street 1:3173 SPRING HOUSE LN
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:18966-2916
Mailing Address - Country:US
Mailing Address - Phone:267-902-3060
Mailing Address - Fax:215-368-7353
Practice Address - Street 1:2727 PHILMONT AVE
Practice Address - Street 2:UNIT 245
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-5311
Practice Address - Country:US
Practice Address - Phone:267-902-3060
Practice Address - Fax:215-368-7353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport