Provider Demographics
NPI:1699892786
Name:AMBIVAN MEDICAL TRANSPORTATION SERVICE INC.
Entity type:Organization
Organization Name:AMBIVAN MEDICAL TRANSPORTATION SERVICE INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAINSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:856-541-1500
Mailing Address - Street 1:PO BOX 51
Mailing Address - Street 2:
Mailing Address - City:AUDUBON
Mailing Address - State:NJ
Mailing Address - Zip Code:08106-0051
Mailing Address - Country:US
Mailing Address - Phone:856-541-1500
Mailing Address - Fax:856-541-1494
Practice Address - Street 1:1492 HADDON AVE.
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-3121
Practice Address - Country:US
Practice Address - Phone:856-541-1500
Practice Address - Fax:856-541-1494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJAMBI00034341600000X, 3416L0300X, 343800000X, 343900000X
344600000X, 347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered341600000XTransportation ServicesAmbulance
Not Answered3416L0300XTransportation ServicesAmbulanceLand Transport
Not Answered343800000XTransportation ServicesSecured Medical Transport (VAN)
Not Answered343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Not Answered344600000XTransportation ServicesTaxi
Not Answered347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2922606Medicaid
NJ2922606Medicaid
NJ210548Medicare ID - Type UnspecifiedDURABLE MEDICAL ID#