Healthcare Provider Details

I. General information

NPI: 1225218407
Provider Name (Legal Business Name): ENCHANTMENT AVIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2805B LAS VEGAS CT
LAS CRUCES NM
88007-4164
US

IV. Provider business mailing address

6402 E SUPERSTITION SPRINGS BLVD SUITE 224
MESA AZ
85206-4392
US

V. Phone/Fax

Practice location:
  • Phone: 505-527-2166
  • Fax: 505-525-2610
Mailing address:
  • Phone: 480-988-3840
  • Fax: 480-988-3843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License NumberTK04080201
License Number StateNM

VIII. Authorized Official

Name: MRS. MARNIE E REDMOND
Title or Position: ASSISTANT DIRECTOR
Credential:
Phone: 480-988-3840