Provider Demographics
NPI:1831302652
Name:LIFE AMBULANCE INC.
Entity Type:Organization
Organization Name:LIFE AMBULANCE INC.
Other - Org Name:LIFE AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:V
Authorized Official - Last Name:BAGRAMYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-552-0000
Mailing Address - Street 1:9998 GLOBAL RD
Mailing Address - Street 2:SUITE 31
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-1010
Mailing Address - Country:US
Mailing Address - Phone:215-552-0000
Mailing Address - Fax:215-552-0035
Practice Address - Street 1:13451 DAMAR DR
Practice Address - Street 2:UNIT K
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116
Practice Address - Country:US
Practice Address - Phone:215-552-0000
Practice Address - Fax:215-552-0035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA=========OtherEIN
PA094036Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER