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General NPI Number Information
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NPI Number | 1770663056
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Entity Type | Organization
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Legal Business Name | EAST TEXAS FLIGHT AMBULANCE
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 03/27/2015
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Provider Practice Location Address
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Address Line | 1000 S BECKHAM AVE
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City | TYLER
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State | TX
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Zip | 75701-1908
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Country | US
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Telephone | 903-531-8285
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Fax | 903-596-3298
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Provider Business Mailing Address
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Address Line | PO BOX 6838
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City | TYLER
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State | TX
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Zip | 75711-6838
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Country | US
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Telephone | 903-531-8285
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Fax | 903-596-3298
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Authorized Official
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Title or Position | DIRECTOR AIR ONE
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Name | MRS. TERRI K. ROWDEN
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Credential | RN, BSN
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Telephone | 903-531-8285
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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 | 212022
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License Number State | TX
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