Provider Demographics
NPI:1598036261
Name:GENESIS MEDICAL TRANSPORT
Entity Type:Organization
Organization Name:GENESIS MEDICAL TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIKHODKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-333-3401
Mailing Address - Street 1:1739 BLEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-3829
Mailing Address - Country:US
Mailing Address - Phone:267-934-1335
Mailing Address - Fax:215-525-6122
Practice Address - Street 1:2180 MARGARET ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-2839
Practice Address - Country:US
Practice Address - Phone:610-333-3401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA110513416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport