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General NPI Number Information
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NPI Number | 1164790168
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Entity Type | Organization
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Legal Business Name | GOSPEL AMBULANCE, INC.
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Dates
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Enumeration Date | 12/05/2011
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Last Update Date | 12/05/2011
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Provider Practice Location Address
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Address Line | 2179 BENNETT RD UNIT A
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City | PHILADELPHIA
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State | PA
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Zip | 19116-3021
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Country | US
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Telephone | 908-420-4110
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Fax | 215-464-5666
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Provider Business Mailing Address
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Address Line | 2179 BENNETT RD UNIT A
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City | PHILADELPHIA
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State | PA
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Zip | 19116-3021
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Country | US
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Telephone | 908-420-4110
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Fax | 215-464-5666
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. IVAN GERTSEN
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Credential |
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Telephone | 908-420-4110
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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 |
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License Number State |
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