Healthcare Provider Details

I. General information

NPI: 1962489187
Provider Name (Legal Business Name): AIR EVAC EMS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 SW 25TH AVE
MINERAL WELLS TX
76067-8244
US

IV. Provider business mailing address

PO BOX 106
WEST PLAINS MO
65775-0106
US

V. Phone/Fax

Practice location:
  • Phone: 940-327-8702
  • Fax: 940-327-8915
Mailing address:
  • Phone: 417-256-0010
  • Fax: 417-257-5761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number182008
License Number StateTX

VIII. Authorized Official

Name: C GREG WITTENBRINK
Title or Position: VP OF FINANCE
Credential:
Phone: 417-256-0010