MEDICARE: ENCHANTMENT AVIATION

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	TK04080201	NM

General Provider Information

NPI Number	:	1225218407
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENCHANTMENT AVIATION

Provider Business Mailing Address
First Line	:	6402 E SUPERSTITION SPRINGS BLVD
Second Line	:	SUITE 224
City	:	MESA
State	:	AZ
Zip	:	85206-4392
Country	:	US
Telephone Number	:	480-988-3840
Fax Number	:	480-988-3843

Provider Business Practice Location Address
First Line	:	2805B LAS VEGAS CT
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88007-4164
Country	:	US
Telephone Number	:	505-527-2166
Fax Number	:	505-525-2610

Authorized Official
Title or Position	:	ASSISTANT DIRECTOR
Name	:	MRS. MARNIE E REDMOND
Credential	:
Telephone Number	:	480-988-3840

Provider Enumeration Date	:	11/06/2007
Last Update Date	:	11/06/2007

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Directions to “ENCHANTMENT AVIATION ” Practice Location

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