MEDICARE: CLASSIC AIR CARE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416A0800X	Air Ambulance	3003L	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AZ0152510	OTHER	AZ	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003855446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLASSIC AIR CARE INC

Provider Business Mailing Address
First Line	:	2244 SOUTH 1640 WEST
Second Line	:
City	:	WOODS CROSS
State	:	UT
Zip	:	84087
Country	:	US
Telephone Number	:	801-295-5700
Fax Number	:	801-443-1993

Provider Business Practice Location Address
First Line	:	2244 SOUTH 1640 WEST
Second Line	:
City	:	WOODS CROSS
State	:	UT
Zip	:	84087
Country	:	US
Telephone Number	:	801-295-5700
Fax Number	:	801-649-0963

Authorized Official
Title or Position	:	DIRECTOR OF FINANCE
Name	:	ERIKO MARTIAN
Credential	:
Telephone Number	:	801-295-5700

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	04/16/2014

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