Healthcare Provider Details

I. General information

NPI: 1194644005
Provider Name (Legal Business Name): AIR INTERFACILITY TRANSPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400A E 20TH ST
FARMINGTON NM
87401-9024
US

IV. Provider business mailing address

1400A E 20TH ST
FARMINGTON NM
87401-9024
US

V. Phone/Fax

Practice location:
  • Phone: 505-787-2095
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JACOB G BENNETT
Title or Position: COO
Credential:
Phone: 505-535-7149