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General NPI Number Information
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NPI Number | 1629416078
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Entity Type | Organization
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Legal Business Name | PREMIUM CARE MEDICAL TRANSPORT LLC
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Dates
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Enumeration Date | 06/07/2013
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Last Update Date | 06/07/2013
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Provider Practice Location Address
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Address Line | 8600 W CHESTER PIKE SUITE 306
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City | UPPER DARBY
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State | PA
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Zip | 19082-2629
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Country | US
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Telephone | 610-446-1339
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Fax | 215-600-1228
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Provider Business Mailing Address
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Address Line | 8600 W CHESTER PIKE SUITE 306
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City | UPPER DARBY
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State | PA
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Zip | 19082-2629
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Country | US
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Telephone | 610-446-1339
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Fax | 215-600-1228
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | SAMUEL CHARLES
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Credential |
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Telephone | 267-227-9133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 13009
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License Number State | PA
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