Healthcare Provider Details

I. General information

NPI: 1093285447
Provider Name (Legal Business Name): JETLYFT AIRMED, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2018
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 MOUNT RUSHMORE RD
RAPID CITY SD
57701-4582
US

IV. Provider business mailing address

3213 W MAIN ST # 305
RAPID CITY SD
57702-2314
US

V. Phone/Fax

Practice location:
  • Phone: 906-828-2280
  • Fax:
Mailing address:
  • Phone: 906-828-2280
  • Fax:

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:

VIII. Authorized Official

Name: BRANDON CARLSON
Title or Position: PRESIDENT
Credential:
Phone: 602-500-8881