Healthcare Provider Details

I. General information

NPI: 1881677995
Provider Name (Legal Business Name): AIR EVAC EMS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 09/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 MEDICAL CENTER DR
JACKSON TN
38301
US

IV. Provider business mailing address

PO BOX 106
WEST PLAINS MO
65775-0106
US

V. Phone/Fax

Practice location:
  • Phone: 731-541-5688
  • Fax: 731-541-5643
Mailing address:
  • Phone: 877-288-5340
  • Fax: 417-257-5761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ERIC THOMAS
Title or Position: SRVP OF REVENUE MANAGEMENT
Credential:
Phone: 877-288-5340