Provider Demographics
NPI:1770644676
Name:CHALFONT EMERGENCY MEDICAL SERVICES, INC.
Entity Type:Organization
Organization Name:CHALFONT EMERGENCY MEDICAL SERVICES, INC.
Other - Org Name:CHAL-BRIT REGIONAL EMERGENCY MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:LEETS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-822-1308
Mailing Address - Street 1:201 PARK AVE
Mailing Address - Street 2:P. O. BOX 506
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-0506
Mailing Address - Country:US
Mailing Address - Phone:215-822-1308
Mailing Address - Fax:215-822-8494
Practice Address - Street 1:201 PARK AVE
Practice Address - Street 2:
Practice Address - City:CHALFONT
Practice Address - State:PA
Practice Address - Zip Code:18914-0506
Practice Address - Country:US
Practice Address - Phone:215-822-1308
Practice Address - Fax:215-822-8494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA061413416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1024032580001Medicaid
PA107143Medicare UPIN