MEDICARE: AIR AMBULANCE INTERNATIONAL LLC

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	347E00000X	Transportation Broker

General Provider Information

NPI Number	:	1548528938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AIR AMBULANCE INTERNATIONAL LLC

Provider Business Mailing Address
First Line	:	1956 CAROLINA AVE NE
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33703-3410
Country	:	US
Telephone Number	:	727-528-8496
Fax Number	:

Provider Business Practice Location Address
First Line	:	1956 CAROLINA AVE NE
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33703-3410
Country	:	US
Telephone Number	:	727-528-8496
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. ALEC STEPHEN WALLACE JR.
Credential	:
Telephone Number	:	727-528-8496

Provider Enumeration Date	:	04/24/2012
Last Update Date	:	04/24/2012

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