Healthcare Provider Details

I. General information

NPI: 1336245463
Provider Name (Legal Business Name): MEMPHIS MEDICAL CENTER AIR AMBULANCE SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 EASTMORELAND AVE
MEMPHIS TN
38104-3327
US

IV. Provider business mailing address

P.O. BOX 205149
DALLAS TX
75320-5149
US

V. Phone/Fax

Practice location:
  • Phone: 901-522-5321
  • Fax:
Mailing address:
  • Phone: 901-522-5321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License NumberEMS0000009906
License Number StateTN

VIII. Authorized Official

Name: MR. JOHN A. BUTORA JR.
Title or Position: CEO
Credential:
Phone: 901-522-5321