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General NPI Number Information
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NPI Number | 1154408391
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Entity Type | Organization
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Legal Business Name | CALIFORNIA SHOCK TRAUMA AIR RESCUE
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 02/07/2008
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Provider Practice Location Address
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Address Line | 4933 BAILEY LOOP
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City | MCCLELLAN
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State | CA
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Zip | 95652
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Country | US
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Telephone | 916-921-4075
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Fax | 916-921-4079
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Provider Business Mailing Address
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Address Line | 4933 BAILEY LOOP
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City | MCCLELLAN
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State | CA
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Zip | 95652
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Country | US
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Telephone | 916-921-4075
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Fax | 916-921-4079
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | JOSEPH F COOK
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Credential |
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Telephone | 916-921-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416A0800X
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Taxonomy Name | Air Ambulance
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License Number | STRA2901
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License Number State |
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