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General NPI Number Information
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NPI Number | 1588305197
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Entity Type | Organization
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Legal Business Name | MOUNTAIN AIR MEDICAL LLC
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Dates
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Enumeration Date | 04/06/2022
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Last Update Date | 04/06/2022
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Provider Practice Location Address
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Address Line | 1250 E AIRPORT RD HNGR 5
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City | JACKSON
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State | WY
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Zip | 83001-8603
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Country | US
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Telephone | 307-413-6085
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2704
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City | IDAHO FALLS
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State | ID
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Zip | 83403-2704
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO FOUNDER
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Name | KIM HARROWER
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Credential |
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Telephone | 307-413-6085
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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 |
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