MEDICARE: NEW TRINITY 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	12033	PA

General Provider Information

NPI Number	:	1669720181
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW TRINITY AMBULANCE LLC

Provider Business Mailing Address
First Line	:	4545 N FRONT ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-1606
Country	:	US
Telephone Number	:	215-514-6297
Fax Number	:	215-613-5652

Provider Business Practice Location Address
First Line	:	4545 N FRONT ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-1606
Country	:	US
Telephone Number	:	215-514-6297
Fax Number	:	215-613-5652

Authorized Official
Title or Position	:	OWNER
Name	:	MR. RONALD H HUMPHREY
Credential	:	EMT
Telephone Number	:	215-514-6297

Provider Enumeration Date	:	08/15/2012
Last Update Date	:	10/09/2013

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Directions to “NEW TRINITY AMBULANCE LLC ” Practice Location

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