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General NPI Number Information
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NPI Number | 1750650750
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Entity Type | Organization
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Legal Business Name | MEDALLIANCE AMBULANCE, LLC
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Dates
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Enumeration Date | 12/20/2011
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Last Update Date | 01/04/2013
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Provider Practice Location Address
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Address Line | 11880 BUSTLETON AVE SUITE 206
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City | PHILADELPHIA
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State | PA
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Zip | 19116
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Country | US
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Telephone | 215-792-6329
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Fax |
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Provider Business Mailing Address
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Address Line | 11880 BUSTLETON AVE SUITE 206
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City | PHILADELPHIA
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State | PA
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Zip | 19116-2538
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Country | US
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Telephone | 215-792-6329
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. MIKAEL M TEMIROV
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Credential | EMT
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Telephone | 215-753-5984
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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 | 156261
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License Number State | PA
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