Provider Demographics
NPI:1215935937
Name:ADVANTAGE AMBULANCE GROUP, INC.
Entity type:Organization
Organization Name:ADVANTAGE AMBULANCE GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LESTER
Authorized Official - Middle Name:J
Authorized Official - Last Name:LISHON
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:610-442-8575
Mailing Address - Street 1:70 FAIRFIELD LANE
Mailing Address - Street 2:
Mailing Address - City:CHESTER SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:19425
Mailing Address - Country:US
Mailing Address - Phone:215-455-5200
Mailing Address - Fax:
Practice Address - Street 1:3235A SUNSET LANE
Practice Address - Street 2:
Practice Address - City:HATBORO
Practice Address - State:PA
Practice Address - Zip Code:19040
Practice Address - Country:US
Practice Address - Phone:215-455-8030
Practice Address - Fax:215-455-4400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA031093416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA069986Medicare ID - Type UnspecifiedAMBULANCE PROVIDER