=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831302652
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIFE AMBULANCE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2007
-----------------------------------------------------
Last Update Date | 04/25/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13451 DAMAR DR UNIT K
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-552-0000
-----------------------------------------------------
Fax | 215-552-0035
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9998 GLOBAL RD SUITE 31
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19115-1010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-552-0000
-----------------------------------------------------
Fax | 215-552-0035
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. GREGORY V BAGRAMYAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 215-552-0000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------