MEDICARE: PLYMOUTH COMMUNITY AMBULANCE ASSN

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	46026	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	281318	OTHER	PA	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639156623
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLYMOUTH COMMUNITY AMBULANCE ASSN

Provider Business Mailing Address
First Line	:	902 GERMANTOWN PIKE
Second Line	:
City	:	PLYMOUTH MEETING
State	:	PA
Zip	:	19462-7400
Country	:	US
Telephone Number	:	610-277-2776
Fax Number	:	610-277-8449

Provider Business Practice Location Address
First Line	:	902 GERMANTOWN PIKE
Second Line	:
City	:	PLYMOUTH MEETING
State	:	PA
Zip	:	19462-7400
Country	:	US
Telephone Number	:	610-277-2776
Fax Number	:	610-277-8449

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	ANDREW M TOMCHO
Credential	:
Telephone Number	:	610-277-2776

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	06/02/2014

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