Provider Demographics
NPI:1699014373
Name:MILLENNIUM MEDICAL TRANSPORTATION, INC
Entity Type:Organization
Organization Name:MILLENNIUM MEDICAL TRANSPORTATION, INC
Other - Org Name:HEARTLINE AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOROTOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-228-5299
Mailing Address - Street 1:2017B JASON DR.
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006
Mailing Address - Country:US
Mailing Address - Phone:267-228-5299
Mailing Address - Fax:
Practice Address - Street 1:9986 GANTRY RD
Practice Address - Street 2:REAR BLD #B
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-1002
Practice Address - Country:US
Practice Address - Phone:267-228-5299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-31
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA130023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport