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General NPI Number Information
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NPI Number | 1053634634
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Entity Type | Organization
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Legal Business Name | PENN CHOICE AMBULANCE INC
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Dates
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Enumeration Date | 03/10/2010
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Last Update Date | 03/10/2010
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Provider Practice Location Address
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Address Line | 3907 HARTZDALE DRIVE SUITE 708
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City | CAMP HILL
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State | PA
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Zip | 17011-7835
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Country | US
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Telephone | 717-525-9656
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Fax | 215-933-5303
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Provider Business Mailing Address
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Address Line | 3907 HARTZDALE DRIVE SUITE 708
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City | CAMP HILL
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State | PA
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Zip | 17011-7835
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Country | US
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Telephone | 717-525-9656
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Fax | 215-933-5303
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANNA MUDROVA
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Credential |
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Telephone | 267-679-1446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 09014
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License Number State | PA
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