Healthcare Provider Details

I. General information

NPI: 1215174768
Provider Name (Legal Business Name): COAST TO COAST AIR AMBULANCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2009
Last Update Date: 03/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3151 AIRPORT LOOP STE 2
SHOW LOW AZ
85901
US

IV. Provider business mailing address

943 S MAIN ST STE 6
CEDAR CITY UT
84720-3890
US

V. Phone/Fax

Practice location:
  • Phone: 928-368-6799
  • Fax: 928-368-8776
Mailing address:
  • Phone: 928-368-6799
  • Fax: 928-368-8776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License Number
License Number State

VIII. Authorized Official

Name: MRS. ROBYNN LEIGH LONGENBAUGH
Title or Position: A/R MANAGER
Credential: CPC
Phone: 928-368-6646