Healthcare Provider Details

I. General information

NPI: 1134279417
Provider Name (Legal Business Name): WYNNEBROOK COMMUNITY AMBULANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 W CHELTENHAM AVE SUITE-7
MELROSE PARK PA
19027-3008
US

IV. Provider business mailing address

1135 W CHELTENHAM AVE SUITE-7
MELROSE PARK PA
19027-3008
US

V. Phone/Fax

Practice location:
  • Phone: 215-635-6255
  • Fax: 215-635-6256
Mailing address:
  • Phone: 215-635-6255
  • Fax: 215-635-6256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number04129
License Number StatePA

VIII. Authorized Official

Name: MR. EARL ZELLARS
Title or Position: CEO
Credential:
Phone: 215-635-6255