Healthcare Provider Details

I. General information

NPI: 1194708909
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: 08/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2979 HIGHWAY B
POPLAR BLUFF MO
63901
US

IV. Provider business mailing address

PO BOX 106
WEST PLAINS MO
65775-0106
US

V. Phone/Fax

Practice location:
  • Phone: 573-274-2082
  • Fax: 573-778-1417
Mailing address:
  • Phone: 417-257-1585
  • Fax: 417-257-5761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierAEL-20 POPLAR BLUFF
Identifier TypeOTHER
Identifier State
Identifier IssuerBASE ID

VIII. Authorized Official

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