Healthcare Provider Details

I. General information

NPI: 1518662998
Provider Name (Legal Business Name): AIR INTERFACILITY TRANSPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 CLARK CARR LOOP SE
ALBUQUERQUE NM
87106-5611
US

IV. Provider business mailing address

PO BOX 2405
SANTA ROSA CA
95405-0405
US

V. Phone/Fax

Practice location:
  • Phone: 505-787-2095
  • Fax:
Mailing address:
  • Phone: 505-535-7149
  • 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: JACOB G BENNETT
Title or Position: COO
Credential:
Phone: 575-551-4648