=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972952091
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MED-X GLOBAL AIR AMBULANCE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2016
-----------------------------------------------------
Last Update Date | 06/09/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50B US HIGHWAY 9
-----------------------------------------------------
City | MORGANVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07751-1526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-536-0515
-----------------------------------------------------
Fax | 888-777-4799
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 220
-----------------------------------------------------
City | MORGANVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07751-0220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-536-0515
-----------------------------------------------------
Fax | 888-777-4799
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | LEONARD AUGUST
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 732-536-0515
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 347E00000X
-----------------------------------------------------
Taxonomy Name | Transportation Broker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3416A0800X
-----------------------------------------------------
Taxonomy Name | Air Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | ZZ
-----------------------------------------------------