Provider Demographics
NPI:1689927170
Name:LEGACY MEDICAL TRANSPORT
Entity Type:Organization
Organization Name:LEGACY MEDICAL TRANSPORT
Other - Org Name:LEGACY AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARITA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAPUSNEANU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-791-4037
Mailing Address - Street 1:301 HEIGHTS LN
Mailing Address - Street 2:5 C
Mailing Address - City:FEASTERVILLE TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-7610
Mailing Address - Country:US
Mailing Address - Phone:267-709-7138
Mailing Address - Fax:
Practice Address - Street 1:3021 FRANKS RD
Practice Address - Street 2:SUITE 7
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-4216
Practice Address - Country:US
Practice Address - Phone:267-709-7138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-21
Last Update Date:2012-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA46090073416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
46090Medicare UPIN
PA46090Medicare UPIN