MEDICARE: AIR EVAC EMS, 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	:	1770036436
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AIR EVAC EMS, INC.

Provider Business Mailing Address
First Line	:	PO BOX 106
Second Line	:
City	:	WEST PLAINS
State	:	MO
Zip	:	65775-0106
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	177 VINCE ASHLEY DR
Second Line	:
City	:	HARRISBURG
State	:	IL
Zip	:	62946-2400
Country	:	US
Telephone Number	:	877-288-5340
Fax Number	:	417-257-5761

Authorized Official
Title or Position	:	SVP OF REVENUE MANAGEMENT
Name	:	ERIC THOMAS
Credential	:
Telephone Number	:	877-288-5340

Provider Enumeration Date	:	07/29/2016
Last Update Date	:	09/26/2018

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