Healthcare Provider Details

I. General information

NPI: 1538115332
Provider Name (Legal Business Name): EAGLE AIR MED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CROWNPOINT MUNICIPAL AIRPORT
CROWNPOINT NM
87313
US

IV. Provider business mailing address

212 FREEDOM WAY
BLANDING UT
84511-3248
US

V. Phone/Fax

Practice location:
  • Phone: 435-678-3222
  • Fax: 435-678-3425
Mailing address:
  • Phone: 435-678-3222
  • Fax: 435-678-3425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License NumberF0009
License Number StateNM

VIII. Authorized Official

Name: MR. ERIC THOMAS
Title or Position: SVP OF REVENUE MANAGEMENT
Credential:
Phone: 417-257-1585