Provider Demographics
NPI:1295891810
Name:MEDCROSS AMBULANCE, INC.
Entity type:Organization
Organization Name:MEDCROSS AMBULANCE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOMOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-464-9999
Mailing Address - Street 1:PO BOX 6131
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-6131
Mailing Address - Country:US
Mailing Address - Phone:215-464-9999
Mailing Address - Fax:215-464-5666
Practice Address - Street 1:2177 BENNETT RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-3021
Practice Address - Country:US
Practice Address - Phone:215-464-9999
Practice Address - Fax:215-464-5666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA033493416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA075711Medicare ID - Type UnspecifiedMEDICARE