Healthcare Provider Details

I. General information

NPI: 1225226780
Provider Name (Legal Business Name): SOUTHWEST AIR AMBULANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 WINGSPAN # DRIVE2
LAS CRUCES NM
88007-9007
US

IV. Provider business mailing address

PO BOX 640
FAIRACRES NM
88033-0640
US

V. Phone/Fax

Practice location:
  • Phone: 505-525-2660
  • Fax:
Mailing address:
  • Phone: 505-525-2660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License NumberF00006
License Number StateNM

VIII. Authorized Official

Name: ROBYNN LONGENBAUGH
Title or Position: A/R MANAGER
Credential:
Phone: 928-368-6799