MEDICARE: GUARDIAN FLIGHT 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	3416A0800X	Air Ambulance

General Provider Information

NPI Number	:	1538685300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUARDIAN FLIGHT LLC

Provider Business Mailing Address
First Line	:	PO BOX 199
Second Line	:
City	:	WEST PLAINS
State	:	MO
Zip	:	65775-0199
Country	:	US
Telephone Number	:	801-619-4900
Fax Number	:	801-983-6052

Provider Business Practice Location Address
First Line	:	120 CARLANNA LAKE RD STE 104
Second Line	:
City	:	KETCHIKAN
State	:	AK
Zip	:	99901-5611
Country	:	US
Telephone Number	:	801-619-4900
Fax Number	:	801-983-6052

Authorized Official
Title or Position	:	SVP OF REVENUE MANAGEMENT
Name	:	ERIC THOMAS
Credential	:
Telephone Number	:	877-288-5340

Provider Enumeration Date	:	08/14/2017
Last Update Date	:	02/28/2020

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Directions to “GUARDIAN FLIGHT LLC ” Practice Location

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