=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841204138
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AEROMED SERVICE SERVICE CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2006
-----------------------------------------------------
Last Update Date | 08/03/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | MEDICAL CENTER HELIPORT CENTRO MEDICO
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00936
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-756-3424
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PMB 411 P O BOX 70344
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00936-8344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-765-3944
-----------------------------------------------------
Fax | 787-765-3160
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | MR. JOSE HERNANDEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-765-3944
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | TCAMB 178
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------