Healthcare Provider Details

I. General information

NPI: 1700814878
Provider Name (Legal Business Name): EMERGENCY TRANSPORT ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 09/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S 11TH ST SUITE 2130
PHILADELPHIA PA
19107-4824
US

IV. Provider business mailing address

PO BOX 8500-51695
PHILADELPHIA PA
19178-0001
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-2700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number04295
License Number StatePA

VIII. Authorized Official

Name: MR. BRIAN SWEENEY
Title or Position: VICE PRESIDENT, CLINICAL / SUPPORT
Credential:
Phone: 215-955-7937