=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821752627
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AIR INTERFACILITY TRANSPORT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2021
-----------------------------------------------------
Last Update Date | 07/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2505 CLARK CARR LOOP SE
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87106-5611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-558-8405
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2405
-----------------------------------------------------
City | SANTA ROSA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95405-0405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-551-4648
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/COO
-----------------------------------------------------
Name | JACOB G BENNETT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 800-558-8405
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------