MEDICARE: GULFSTREAM AMBULANCE LLC.

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	04103	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0000940000	OTHER	PA	AMBULANCE PROVIDER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316064165
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GULFSTREAM AMBULANCE LLC.

Provider Business Mailing Address
First Line	:	11301 NORCOM RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19154-2311
Country	:	US
Telephone Number	:	215-677-3625
Fax Number	:	215-677-3016

Provider Business Practice Location Address
First Line	:	11301 NORCOM RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19154-2311
Country	:	US
Telephone Number	:	215-677-3625
Fax Number	:	215-677-3016

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JULIA EPSHTEYN
Credential	:
Telephone Number	:	215-677-3625

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	11/14/2012

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