Provider Demographics
NPI:1659409902
Name:PROLIFE AMBULANCE INC
Entity Type:Organization
Organization Name:PROLIFE AMBULANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARAT
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGRAMYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-333-1112
Mailing Address - Street 1:PO BOX 6119
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-6119
Mailing Address - Country:US
Mailing Address - Phone:215-333-1112
Mailing Address - Fax:215-938-7416
Practice Address - Street 1:2903 FRANKS RD
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-4214
Practice Address - Country:US
Practice Address - Phone:215-333-1112
Practice Address - Fax:215-938-7416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA066251Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER