Healthcare Provider Details

I. General information

NPI: 1205272440
Provider Name (Legal Business Name): EAGLEMED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2013
Last Update Date: 09/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 DUGGLEBY DRIVE
CODY WY
82414-0000
US

IV. Provider business mailing address

PO BOX 108
WEST PLAINS MO
65775-0108
US

V. Phone/Fax

Practice location:
  • Phone: 877-288-5340
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: SVP OF REVENUE MANAGEMENT
Credential:
Phone: 877-288-5340