Healthcare Provider Details

I. General information

NPI: 1316949951
Provider Name (Legal Business Name): AIR ANGELS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 KRESS RD
WEST CHICAGO IL
60185-1810
US

IV. Provider business mailing address

320 KRESS RD
WEST CHICAGO IL
60185-1810
US

V. Phone/Fax

Practice location:
  • Phone: 630-876-7215
  • Fax: 630-876-7249
Mailing address:
  • Phone: 630-876-7215
  • Fax: 630-876-7249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License Number0734
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number9 7964
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License Number8 796408
License Number StateIL

VIII. Authorized Official

Name: MR. MICHAEL DERMONT
Title or Position: CEO
Credential:
Phone: 630-876-7215