Healthcare Provider Details

I. General information

NPI: 1992574388
Provider Name (Legal Business Name): CHARTER AMBULANCE TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2023
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E BROADWAY STE 1
RED LION PA
17356-8856
US

IV. Provider business mailing address

113 PENNY LN
NEW FREEDOM PA
17349-9450
US

V. Phone/Fax

Practice location:
  • Phone: 717-954-5853
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KEVIN COPELAND
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 717-858-8477