MEDICARE: ADVANTAGE AMBULANCE GROUP, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	03109	PA

General Provider Information

NPI Number	:	1215935937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANTAGE AMBULANCE GROUP, INC.

Provider Business Mailing Address
First Line	:	70 FAIRFIELD LANE
Second Line	:
City	:	CHESTER SPRINGS
State	:	PA
Zip	:	19425
Country	:	US
Telephone Number	:	215-455-5200
Fax Number	:

Provider Business Practice Location Address
First Line	:	3235A SUNSET LANE
Second Line	:
City	:	HATBORO
State	:	PA
Zip	:	19040
Country	:	US
Telephone Number	:	215-455-8030
Fax Number	:	215-455-4400

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. LESTER J LISHON IV
Credential	:
Telephone Number	:	610-442-8575

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	10/29/2013

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