Provider Demographics
NPI:1801884507
Name:EAST COAST AMBULANCE SERVICE LLC
Entity type:Organization
Organization Name:EAST COAST AMBULANCE SERVICE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:ROSELLINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-663-2012
Mailing Address - Street 1:9505 HARFORD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-3112
Mailing Address - Country:US
Mailing Address - Phone:410-663-2012
Mailing Address - Fax:410-663-2015
Practice Address - Street 1:9505 HARFORD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-3112
Practice Address - Country:US
Practice Address - Phone:410-663-2012
Practice Address - Fax:410-663-2015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD0000823416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD300106700Medicaid
MD687QOtherEMI
MDTR29OtherBC/BS BELL ATLANTIC CASCI
MDTR29OtherMAGELLAN
MDTR29OtherBC/BS NATIONAL ACCOUNTS
MDTR29OtherHIGHMARK
MDTR29OtherBC/BS MD
MD147509000OtherOWCP
MDR2490001OtherBC/BS FEDERAL
MD8100047OtherEVERCARE HEALTH
MDTR29OtherBC/BS BLUE CHOICE
MDTR29OtherHIGHMARK
MDTR29OtherBC/BS BELL ATLANTIC CASCI