Healthcare Provider Details

I. General information

NPI: 1679750079
Provider Name (Legal Business Name): AIRMED DOMESTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 N MARGINAL RD
CLEVELAND OH
44114-3739
US

IV. Provider business mailing address

1000 URBAN CENTER DR SUITE 470
BIRMINGHAM AL
35242-2532
US

V. Phone/Fax

Practice location:
  • Phone: 216-861-2030
  • Fax:
Mailing address:
  • Phone: 205-443-4840
  • Fax: 205-443-4841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License Number
License Number StateOH

VIII. Authorized Official

Name: MR. JEFFREY T. TOLBERT
Title or Position: PRESIDENT
Credential:
Phone: 205-443-4840