Provider Demographics
NPI:1750650750
Name:MEDALLIANCE AMBULANCE, LLC
Entity Type:Organization
Organization Name:MEDALLIANCE AMBULANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKAEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:TEMIROV
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:215-753-5984
Mailing Address - Street 1:11880 BUSTLETON AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-2538
Mailing Address - Country:US
Mailing Address - Phone:215-792-6329
Mailing Address - Fax:
Practice Address - Street 1:11880 BUSTLETON AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116
Practice Address - Country:US
Practice Address - Phone:215-792-6329
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-20
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA156261341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance