MEDICARE: MEDCROSS AMBULANCE, 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	03349	PA

General Provider Information

NPI Number	:	1295891810
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDCROSS AMBULANCE, INC.

Provider Business Mailing Address
First Line	:	PO BOX 6131
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19115-6131
Country	:	US
Telephone Number	:	215-464-9999
Fax Number	:	215-464-5666

Provider Business Practice Location Address
First Line	:	2177 BENNETT RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19116-3021
Country	:	US
Telephone Number	:	215-464-9999
Fax Number	:	215-464-5666

Authorized Official
Title or Position	:	PRESIDENT
Name	:	OLGA LOMOVA
Credential	:
Telephone Number	:	215-464-9999

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	08/22/2020

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