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General NPI Number Information
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NPI Number | 1477846889
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Entity Type | Organization
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Legal Business Name | MEDIVAC AIR RESCUE, INC.
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Dates
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Enumeration Date | 05/17/2011
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Last Update Date | 05/17/2011
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Provider Practice Location Address
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Address Line | 5751 KROGER DR SUITE 230
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City | FORT WORTH
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State | TX
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Zip | 76244-5632
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Country | US
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Telephone | 877-260-3575
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Fax | 877-514-2571
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Provider Business Mailing Address
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Address Line | 5751 KROGER DR SUITE 230
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City | FORT WORTH
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State | TX
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Zip | 76244-5632
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Country | US
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Telephone | 877-260-3575
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Fax | 877-514-2571
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. MICHAEL A NELSON
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Credential | NREMT-P
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Telephone | 877-260-3575
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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 |
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License Number State | TX
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