MEDICARE: LIFE FLIGHT OF PUERTO RICO 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

General Provider Information

NPI Number	:	1326231085
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE FLIGHT OF PUERTO RICO INC.

Provider Business Mailing Address
First Line	:	PO BOX 13638
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00908-3638
Country	:	US
Telephone Number	:	787-289-2701
Fax Number	:	787-289-9090

Provider Business Practice Location Address
First Line	:	VIA PRINCIPAL HANGAR #4 SUR
Second Line	:	ISLA GRANDE AIRPORT
City	:	SAN JUAN
State	:	PR
Zip	:	00907-0000
Country	:	US
Telephone Number	:	787-289-2701
Fax Number	:	787-289-9090

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. FRANCES M VAZQUEZ
Credential	:
Telephone Number	:	787-289-2701

Provider Enumeration Date	:	08/24/2007
Last Update Date	:	08/24/2007

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