Healthcare Provider Details

I. General information

NPI: 1508427352
Provider Name (Legal Business Name): APOLLO MEDFLIGHT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 AIRPORT RD
PINE RIDGE SD
57770
US

IV. Provider business mailing address

PO BOX 63
AMARILLO TX
79105-0063
US

V. Phone/Fax

Practice location:
  • Phone: 806-322-4448
  • Fax:
Mailing address:
  • Phone: 806-242-9028
  • Fax: 888-978-5029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2020116
Identifier TypeMEDICAID
Identifier StateSD
Identifier Issuer

VIII. Authorized Official

Name: ROBERT DORRIS
Title or Position: CFO
Credential:
Phone: 806-359-4699