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General NPI Number Information
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NPI Number | 1295088029
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Entity Type | Organization
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Legal Business Name | EXECMED, LLC
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Dates
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Enumeration Date | 10/17/2012
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Last Update Date | 09/12/2013
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Provider Practice Location Address
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Address Line | 8244 122ND AVE NE
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City | KIRKLAND
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State | WA
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Zip | 98033-8017
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Country | US
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Telephone | 855-633-3544
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 55
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City | WATSONTOWN
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State | PA
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Zip | 17777-0055
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Country | US
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Telephone | 570-538-4488
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DAVID HEDEQUIST
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Credential |
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Telephone | 855-633-3544
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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 | AIR.ES.60303866
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License Number State | WA
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