Healthcare Provider Details

I. General information

NPI: 1154435238
Provider Name (Legal Business Name): GALLUP MED FLIGHT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 08/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 W HISTORIC HIGHWAY 66
GALLUP NM
87301
US

IV. Provider business mailing address

10888 S 300 W
SOUTH JORDAN UT
84095-4043
US

V. Phone/Fax

Practice location:
  • Phone: 801-619-4900
  • Fax: 801-619-8077
Mailing address:
  • Phone: 801-619-4900
  • Fax: 801-619-8077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License Number06-00000788
License Number StateNM

VIII. Authorized Official

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