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General NPI Number Information
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NPI Number | 1538115332
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Entity Type | Organization
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Legal Business Name | EAGLE AIR MED
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 07/21/2017
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Provider Practice Location Address
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Address Line | CROWNPOINT MUNICIPAL AIRPORT
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City | CROWNPOINT
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State | NM
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Zip | 87313
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Country | US
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Telephone | 435-678-3222
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Fax | 435-678-3425
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Provider Business Mailing Address
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Address Line | 212 FREEDOM WAY
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City | BLANDING
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State | UT
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Zip | 84511-3248
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Country | US
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Telephone | 435-678-3222
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Fax | 435-678-3425
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Authorized Official
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Title or Position | SVP OF REVENUE MANAGEMENT
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Name | MR. ERIC THOMAS
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Credential |
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Telephone | 417-257-1585
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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 | F0009
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License Number State | NM
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