Healthcare Provider Details

I. General information

NPI: 1407839202
Provider Name (Legal Business Name): AIR EVAC EMS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 09/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 BROADWAY ST
QUINCY IL
62301
US

IV. Provider business mailing address

PO BOX 106
WEST PLAINS MO
65775-0106
US

V. Phone/Fax

Practice location:
  • Phone: 217-222-9632
  • Fax: 217-222-4913
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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