Provider Demographics
NPI:1124251681
Name:PLATINUM AMBULANCE INC.
Entity type:Organization
Organization Name:PLATINUM AMBULANCE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SERGEY
Authorized Official - Middle Name:V
Authorized Official - Last Name:NABOKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-947-5800
Mailing Address - Street 1:140 TOMLINSON RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-4259
Mailing Address - Country:US
Mailing Address - Phone:215-947-5800
Mailing Address - Fax:215-947-5801
Practice Address - Street 1:140 TOMLINSON RD
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-4259
Practice Address - Country:US
Practice Address - Phone:215-947-5800
Practice Address - Fax:215-947-5801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-01
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA09022341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance