MEDICARE: WYNNEBROOK COMMUNITY AMBULANCE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance	04129	PA

General Provider Information

NPI Number	:	1134279417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WYNNEBROOK COMMUNITY AMBULANCE

Provider Business Mailing Address
First Line	:	1135 W CHELTENHAM AVE
Second Line	:	SUITE-7
City	:	MELROSE PARK
State	:	PA
Zip	:	19027-3008
Country	:	US
Telephone Number	:	215-635-6255
Fax Number	:	215-635-6256

Provider Business Practice Location Address
First Line	:	1135 W CHELTENHAM AVE
Second Line	:	SUITE-7
City	:	MELROSE PARK
State	:	PA
Zip	:	19027-3008
Country	:	US
Telephone Number	:	215-635-6255
Fax Number	:	215-635-6256

Authorized Official
Title or Position	:	CEO
Name	:	MR. EARL ZELLARS
Credential	:
Telephone Number	:	215-635-6255

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	08/22/2020

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Directions to “WYNNEBROOK COMMUNITY AMBULANCE ” Practice Location

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