MEDICARE: AIRMED DOMESTIC 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	3416A0800X	Air Ambulance		OH

General Provider Information

NPI Number	:	1679750079
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AIRMED DOMESTIC LLC

Provider Business Mailing Address
First Line	:	1000 URBAN CENTER DR
Second Line	:	SUITE 470
City	:	BIRMINGHAM
State	:	AL
Zip	:	35242-2532
Country	:	US
Telephone Number	:	205-443-4840
Fax Number	:	205-443-4841

Provider Business Practice Location Address
First Line	:	1601 N MARGINAL RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44114-3739
Country	:	US
Telephone Number	:	216-861-2030
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JEFFREY T. TOLBERT
Credential	:
Telephone Number	:	205-443-4840

Provider Enumeration Date	:	01/28/2008
Last Update Date	:	01/28/2008

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Directions to “AIRMED DOMESTIC LLC ” Practice Location

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