Provider Demographics
NPI:1881649739
Name:MIDLANTIC MEDICAL TRANSPORT, INC.
Entity Type:Organization
Organization Name:MIDLANTIC MEDICAL TRANSPORT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:DISPOTO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:215-224-5100
Mailing Address - Street 1:5512 N FRONT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-2921
Mailing Address - Country:US
Mailing Address - Phone:215-224-5100
Mailing Address - Fax:215-224-1200
Practice Address - Street 1:5512 N FRONT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19120-2921
Practice Address - Country:US
Practice Address - Phone:215-224-5100
Practice Address - Fax:215-224-1200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05002341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA053057Medicare ID - Type UnspecifiedAMBULANCE PROVIDER