MEDICARE: AIRAMEDIC, 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	3416L0300X	Land Ambulance
2	3416A0800X	Air Ambulance

General Provider Information

NPI Number	:	1750778601
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AIRAMEDIC, LLC

Provider Business Mailing Address
First Line	:	1956 CAROLINA AVE NE
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33703-3410
Country	:	US
Telephone Number	:	727-528-8496
Fax Number	:	888-762-9665

Provider Business Practice Location Address
First Line	:	1956 CAROLINA AVE NE
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33703-3410
Country	:	US
Telephone Number	:	727-528-8496
Fax Number	:	888-762-9665

Authorized Official
Title or Position	:	A/R MANAGER
Name	:	MS. ROBYNN LONGENBAUGH
Credential	:
Telephone Number	:	928-368-6799

Provider Enumeration Date	:	04/17/2015
Last Update Date	:	04/17/2015

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Directions to “AIRAMEDIC, LLC ” Practice Location

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