Healthcare Provider Details

I. General information

NPI: 1578609418
Provider Name (Legal Business Name): GATEWAY AIR AMBULANCE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 11/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 E. RIO SALADO PARKWAY SUITE 900
TEMPE AZ
85281
US

IV. Provider business mailing address

P.O. BOX 26785
OVERLAND PARK KS
66225-6785
US

V. Phone/Fax

Practice location:
  • Phone: 913-663-5535
  • Fax: 913-663-1503
Mailing address:
  • Phone: 913-663-5535
  • Fax: 913-663-1503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License Number06-0009
License Number StateAZ

VIII. Authorized Official

Name: DAVID CARL CARLSON
Title or Position: VICE PRESIDENT
Credential:
Phone: 913-663-5535