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General NPI Number Information
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NPI Number | 1164653259
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Entity Type | Organization
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Legal Business Name | LIBERTY MEDICAL RESPONSE LLC.
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Dates
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Enumeration Date | 08/06/2009
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Last Update Date | 08/06/2009
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Provider Practice Location Address
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Address Line | 9998 GLOBAL RD. SUITE 29
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City | PHILADELPHIA
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State | PA
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Zip | 19115-1010
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Country | US
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Telephone | 215-464-8560
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Fax | 215-689-2997
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Provider Business Mailing Address
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Address Line | 9998 GLOBAL RD. SUITE 29
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City | PHILADELPHIA
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State | PA
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Zip | 19115-1010
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Country | US
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Telephone | 215-464-8560
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Fax | 215-689-2997
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Authorized Official
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Title or Position | PARTNER/OWNER
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Name | MR. ANDREY WLADIMIROVICH ZELENYUK
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Credential | EMT
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Telephone | 215-464-8560
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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 | 169243
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License Number State | PA
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