MEDICARE: LIBERTY MEDICAL RESPONSE LLC.

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	3416L0300X	Land Ambulance	169243	PA

General Provider Information

NPI Number	:	1164653259
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBERTY MEDICAL RESPONSE LLC.

Provider Business Mailing Address
First Line	:	9998 GLOBAL RD.
Second Line	:	SUITE 29
City	:	PHILADELPHIA
State	:	PA
Zip	:	19115-1010
Country	:	US
Telephone Number	:	215-464-8560
Fax Number	:	215-689-2997

Provider Business Practice Location Address
First Line	:	9998 GLOBAL RD.
Second Line	:	SUITE 29
City	:	PHILADELPHIA
State	:	PA
Zip	:	19115-1010
Country	:	US
Telephone Number	:	215-464-8560
Fax Number	:	215-689-2997

Authorized Official
Title or Position	:	PARTNER/OWNER
Name	:	MR. ANDREY WLADIMIROVICH ZELENYUK
Credential	:	EMT
Telephone Number	:	215-464-8560

Provider Enumeration Date	:	08/06/2009
Last Update Date	:	08/06/2009

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