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NPI Code Detail

MEDICARE: MIDWEST MEDFLIGHT

MEDICARE: MIDWEST MEDFLIGHT
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
13416A0800XAir Ambulance811007MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
159OH10002OTHERMIBCBSMI

General Provider Information

NPI Number : 1073517942
Entity Type Code : Organization
Provider Name (Legal Business Name) : MIDWEST MEDFLIGHT
Provider Business Mailing Address
First Line : 5305 MCAULEY DR
Second Line : # 311
City : YPSILANTI
State : MI
Zip : 48197-1051
Country : US
Telephone Number : 734-712-3104
Fax Number : 816-431-4973
Provider Business Practice Location Address
First Line : 5305 MCAULEY DR
Second Line : # 311
City : YPSILANTI
State : MI
Zip : 48197-1051
Country : US
Telephone Number : 734-712-3104
Fax Number : 816-431-4973
Authorized Official
Title or Position : PROGRAM DIRECTOR
Name : JUDY KETTENSTOCK
Credential : RN
Telephone Number : 734-712-3104
Provider Enumeration Date : 06/09/2005
Last Update Date : 04/20/2008

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Directions to “MIDWEST MEDFLIGHT ” Practice Location

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