=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184962334
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMERGENCY MEDIVAC SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2013
-----------------------------------------------------
Last Update Date | 11/18/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 925 B ST #102
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92101-4616
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-342-7408
-----------------------------------------------------
Fax | 610-342-7410
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 925 B ST #102
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92101-4616
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-342-7408
-----------------------------------------------------
Fax | 619-342-7410
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER MANAGER
-----------------------------------------------------
Name | MR. PAUL G BERNER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 858-245-9762
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416A0800X
-----------------------------------------------------
Taxonomy Name | Air Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------