Provider Demographics
NPI:1356579429
Name:PENN CHOICE AMBULANCE INC.
Entity type:Organization
Organization Name:PENN CHOICE AMBULANCE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUDROVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-679-1446
Mailing Address - Street 1:3907 HARTZDALE DR
Mailing Address - Street 2:SUITE 708
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-7835
Mailing Address - Country:US
Mailing Address - Phone:717-525-9656
Mailing Address - Fax:215-933-5303
Practice Address - Street 1:3907 HARTZDALE DR
Practice Address - Street 2:SUITE 708
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-7835
Practice Address - Country:US
Practice Address - Phone:717-525-9656
Practice Address - Fax:215-933-5303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-29
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA110283416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport