Healthcare Provider Details

I. General information

NPI: 1891746590
Provider Name (Legal Business Name): EAGLE AIR MED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 09/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 STATE AVENUE SAN LUIS VALLEY REGIONAL AIRPORT BERGMAN FIELD
ALAMOSA CO
81101
US

IV. Provider business mailing address

212 FREEDOM WAY
BLANDING UT
84511-3248
US

V. Phone/Fax

Practice location:
  • Phone: 435-678-3222
  • Fax: 435-678-3425
Mailing address:
  • Phone: 435-678-3222
  • Fax: 435-678-3425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License NumberA003
License Number StateCO

VIII. Authorized Official

Name: ERIC THOMAS
Title or Position: SVP OF REVENUE MANAGEMENT
Credential:
Phone: 877-288-5340