Provider Demographics
NPI:1659302149
Name:PHILADELPHIA AMBULANCE
Entity Type:Organization
Organization Name:PHILADELPHIA AMBULANCE
Other - Org Name:AMERIHEART AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVENZON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-676-7200
Mailing Address - Street 1:13440 DAMAR DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-1817
Mailing Address - Country:US
Mailing Address - Phone:215-676-7200
Mailing Address - Fax:215-676-2806
Practice Address - Street 1:13440 DAMAR DR
Practice Address - Street 2:SUITE G
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-1817
Practice Address - Country:US
Practice Address - Phone:215-676-7200
Practice Address - Fax:215-676-2806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA031903416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0058238Medicaid
PA0002049000OtherKEYSTONE HEALTH PLAN EAST
PAP00060300OtherRAILROAD MEDICARE
PA0002049000OtherAMERIHEALTH
PA0019703770001Medicaid
PA2049OtherINDEP. BLUE CROSS
PA710200PA19116OtherBC/BS OF MICHIGAN
PA3427265OtherAETNA
PA30014238OtherKEYSTONE MERCY
PA34218OtherHEALTHPARTNERS
PA=========OtherAARP
PA0002049000OtherKEYSTONE HEALTH PLAN EAST
PA30014238OtherKEYSTONE MERCY
PA0019703770001Medicaid
NJ0058238Medicaid