=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972073310
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTERNATIONAL AIR CHARTERS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/28/2018
-----------------------------------------------------
Last Update Date | 11/28/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 N RIVERHILLS RD
-----------------------------------------------------
City | KINGSFORD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49802-6624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 906-828-2280
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 N RIVERHILLS RD
-----------------------------------------------------
City | KINGSFORD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49802-6624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 906-828-2280
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | BRANDON CARLSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 602-500-8881
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 344800000X
-----------------------------------------------------
Taxonomy Name | Air Carrier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------