MEDICARE: 4 LIFE 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	341600000X	Ambulance

General Provider Information

NPI Number	:	1316233273
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	4 LIFE AMBULANCE INC

Provider Business Mailing Address
First Line	:	842 RED LION RD STE 21
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19115-1475
Country	:	US
Telephone Number	:	267-980-9182
Fax Number	:	215-464-1669

Provider Business Practice Location Address
First Line	:	842 RED LION RD STE 21
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19115-1475
Country	:	US
Telephone Number	:	267-980-9182
Fax Number	:	215-464-1669

Authorized Official
Title or Position	:	PARTNER
Name	:	MRS. RENEE ANTIONETTE MCBRIDE
Credential	:
Telephone Number	:	267-980-9182

Provider Enumeration Date	:	06/20/2011
Last Update Date	:	06/20/2011

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