MEDICARE: CHILDREN'S AIR AMBULANCE INTERNATIONAL, INC.

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	AIR648	FL

General Provider Information

NPI Number	:	1669926143
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDREN'S AIR AMBULANCE INTERNATIONAL, INC.

Provider Business Mailing Address
First Line	:	1550 W CYPRESS CREEK RD
Second Line	:	HANGER 18
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-1802
Country	:	US
Telephone Number	:	954-200-6977
Fax Number	:

Provider Business Practice Location Address
First Line	:	1550 W CYPRESS CREEK RD
Second Line	:	HANGER 18
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-1802
Country	:	US
Telephone Number	:	954-200-6977
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. GUILLERMO TEJADA
Credential	:	CCEMT-P
Telephone Number	:	917-202-8622

Provider Enumeration Date	:	08/12/2016
Last Update Date	:	08/12/2016

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