Provider Demographics
NPI:1265748321
Name:PENNCROSS AMBULANCE SERVICE LLC
Entity type:Organization
Organization Name:PENNCROSS AMBULANCE SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:INTISAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:ESSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-964-4001
Mailing Address - Street 1:67 BUCK RD
Mailing Address - Street 2:SUITE 183 BOX 26
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-1535
Mailing Address - Country:US
Mailing Address - Phone:215-964-4001
Mailing Address - Fax:215-526-2758
Practice Address - Street 1:67 BUCK RD
Practice Address - Street 2:SUITE 183 BOX 26
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-1535
Practice Address - Country:US
Practice Address - Phone:215-964-4001
Practice Address - Fax:215-526-2758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA100203416L0300X, 341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport