Provider Demographics
NPI:1700157740
Name:ALLEGIANCE AMBULANCE INC
Entity Type:Organization
Organization Name:ALLEGIANCE AMBULANCE INC
Other - Org Name:ALLEGIANCE AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAVEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTOVETS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-715-1921
Mailing Address - Street 1:1323 KATIE LN
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-1336
Mailing Address - Country:US
Mailing Address - Phone:215-715-1921
Mailing Address - Fax:215-343-8070
Practice Address - Street 1:328 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:HORSHAM
Practice Address - State:PA
Practice Address - Zip Code:19044-2125
Practice Address - Country:US
Practice Address - Phone:215-715-1921
Practice Address - Fax:215-343-8070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA120013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport