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General NPI Number Information
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NPI Number | 1336245463
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Entity Type | Organization
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Legal Business Name | MEMPHIS MEDICAL CENTER AIR AMBULANCE SERVICE, INC.
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 01/27/2015
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Provider Practice Location Address
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Address Line | 1080 EASTMORELAND AVE
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City | MEMPHIS
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State | TN
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Zip | 38104-3327
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Country | US
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Telephone | 901-522-5321
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 205149
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City | DALLAS
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State | TX
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Zip | 75320-5149
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Country | US
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Telephone | 901-522-5321
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. JOHN A. BUTORA JR.
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Credential |
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Telephone | 901-522-5321
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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 | EMS0000009906
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License Number State | TN
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