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General NPI Number Information
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NPI Number | 1801520671
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Entity Type | Organization
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Legal Business Name | AIR INTERFACILITY TRANSPORT
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Dates
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Enumeration Date | 07/15/2022
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Last Update Date | 07/15/2022
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Provider Practice Location Address
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Address Line | 900 SULLIVAN AVE
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City | FARMINGTON
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State | NM
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Zip | 87401-7359
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Country | US
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Telephone | 505-588-0222
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Fax |
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Provider Business Mailing Address
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Address Line | 10 ROAD 1740
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City | FARMINGTON
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State | NM
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Zip | 87401-9616
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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 | COO
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Name | JACOB G BENNETT
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Credential |
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Telephone | 575-551-4648
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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