Provider Demographics
NPI:1518016948
Name:MEDEX AMBULANCE, INC
Entity Type:Organization
Organization Name:MEDEX AMBULANCE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAGORODNY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-355-3636
Mailing Address - Street 1:PO BOX 14589
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-0589
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:341 PHILMONT AVE
Practice Address - Street 2:SHOP 2 AND 3
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-6406
Practice Address - Country:US
Practice Address - Phone:215-355-3636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA04234341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0001767000OtherBLUE CROSS BLUE SHIELD
PA1011890820001Medicaid
PA36169OtherHEALTH PARTNERS
PA0001767000OtherBLUE CROSS BLUE SHIELD