Provider Demographics
NPI:1457645343
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 1:9301 NEIL RD
Mailing Address - Street 2:UNIT B
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-4275
Mailing Address - Country:US
Mailing Address - Phone:267-679-1446
Mailing Address - Fax:215-933-5303
Practice Address - Street 1:3021 FRANKS RD
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-4216
Practice Address - Country:US
Practice Address - Phone:267-679-1446
Practice Address - Fax:215-933-5303
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PENN CHOICE AMBULANCE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA110283416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport