Healthcare Provider Details

I. General information

NPI: 1154408391
Provider Name (Legal Business Name): CALIFORNIA SHOCK TRAUMA AIR RESCUE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 02/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4933 BAILEY LOOP
MCCLELLAN CA
95652
US

IV. Provider business mailing address

4933 BAILEY LOOP
MCCLELLAN CA
95652
US

V. Phone/Fax

Practice location:
  • Phone: 916-921-4075
  • Fax: 916-921-4079
Mailing address:
  • Phone: 916-921-4075
  • Fax: 916-921-4079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License NumberSTRA2901
License Number State

VIII. Authorized Official

Name: JOSEPH F COOK
Title or Position: PRESIDENT & CEO
Credential:
Phone: 916-921-4000