MEDICARE: EXPRESS AVIATION SERVICES, 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	0561	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164846416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXPRESS AVIATION SERVICES, INC.

Provider Business Mailing Address
First Line	:	200 2ND AVE S
Second Line	:	506
City	:	ST PETERSBURG
State	:	FL
Zip	:	33701-4313
Country	:	US
Telephone Number	:	800-304-8094
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 2ND AVE S
Second Line	:	506
City	:	ST PETERSBURG
State	:	FL
Zip	:	33701-4313
Country	:	US
Telephone Number	:	800-304-8094
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KENNETH CHARLES FOX
Credential	:
Telephone Number	:	800-304-8094

Provider Enumeration Date	:	02/06/2014
Last Update Date	:	05/18/2016

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