Provider Demographics
NPI:1609885821
Name:AMBULANCE EXPRESS INC
Entity Type:Organization
Organization Name:AMBULANCE EXPRESS INC
Other - Org Name:MEDSTAR EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAVCHUK
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:215-778-3608
Mailing Address - Street 1:444 FILLMORE ST
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-4329
Mailing Address - Country:US
Mailing Address - Phone:215-778-3608
Mailing Address - Fax:215-706-0300
Practice Address - Street 1:4320 H ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-4346
Practice Address - Country:US
Practice Address - Phone:215-744-4500
Practice Address - Fax:215-744-4565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05141341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014224550001Medicaid
PA093459Medicare ID - Type Unspecified