Healthcare Provider Details

I. General information

NPI: 1265748321
Provider Name (Legal Business Name): PENNCROSS AMBULANCE SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2010
Last Update Date: 08/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 BUCK RD SUITE 183 BOX 26
HUNTINGDON VALLEY PA
19006-1535
US

IV. Provider business mailing address

67 BUCK RD SUITE 183 BOX 26
HUNTINGDON VALLEY PA
19006-1535
US

V. Phone/Fax

Practice location:
  • Phone: 215-964-4001
  • Fax: 215-526-2758
Mailing address:
  • Phone: 215-964-4001
  • Fax: 215-526-2758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number10020
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number10020
License Number StatePA

VIII. Authorized Official

Name: INTISAR A ESSA
Title or Position: DIRECT OWNER
Credential:
Phone: 215-964-4001