Healthcare Provider Details

I. General information

NPI: 1295011674
Provider Name (Legal Business Name): FREEDOM AMBULANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2011
Last Update Date: 10/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5512 BORTNER RD
UPPERCO MD
21155-9763
US

IV. Provider business mailing address

5512 BORTNER RD
UPPERCO MD
21155-9763
US

V. Phone/Fax

Practice location:
  • Phone: 443-536-4077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. EDWARD SENKBEIL
Title or Position: CEO
Credential:
Phone: 443-536-4077