Healthcare Provider Details

I. General information

NPI: 1760415137
Provider Name (Legal Business Name): AIRSTATION TRAVERSE CITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 AIRPORT ACCESS RD FLIGHT MED CLINIC
TRAVERSE CITY MI
49686-3513
US

IV. Provider business mailing address

2012 E FRONT ST
TRAVERSE CITY MI
49686-3023
US

V. Phone/Fax

Practice location:
  • Phone: 231-922-8282
  • Fax: 231-922-8292
Mailing address:
  • Phone: 231-631-4660
  • Fax: 231-922-8292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number45189021
License Number StateWI

VIII. Authorized Official

Name: MRS. ELVIRA FABIOLA LOMBARDO
Title or Position: HS3
Credential: HEALTH SERVICES TECH
Phone: 231-922-8282