=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164906541
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RRR AIR EVAC, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2018
-----------------------------------------------------
Last Update Date | 03/18/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 160 N SHORE LN
-----------------------------------------------------
City | GILBERT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85233-5204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-719-7153
-----------------------------------------------------
Fax | 308-365-6804
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1561
-----------------------------------------------------
City | CHANDLER
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85244-1561
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-777-8377
-----------------------------------------------------
Fax | 308-365-6804
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF OPERATING OFFICER
-----------------------------------------------------
Name | MR. CHEYENNE RENE LORD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 517-777-8377
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 347E00000X
-----------------------------------------------------
Taxonomy Name | Transportation Broker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3416A0800X
-----------------------------------------------------
Taxonomy Name | Air Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------