1336245463 NPI number — MEMPHIS MEDICAL CENTER AIR AMBULANCE SERVICE, INC.

Table of content: (NPI 1336245463)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336245463 NPI number — MEMPHIS MEDICAL CENTER AIR AMBULANCE SERVICE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEMPHIS MEDICAL CENTER AIR AMBULANCE SERVICE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HOSPITAL WING
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336245463
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 205149
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75320-5149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-522-5321
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1080 EASTMORELAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38104-3327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-522-5321
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BUTORA
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
901-522-5321

Provider Taxonomy Codes

  • Taxonomy code: 3416A0800X , with the licence number:  EMS0000009906 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3574476 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4043897 . This is a "BC/BS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 5500075600 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 160813501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4043897 . This is a "TENNCARE SELECT" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 148123715 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 805962206 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00553958 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 132775 . This is a "TENNCARE BETTER HEALTH" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 22924 . This is a "TLC" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 55982 . This is a "TENNCARE OMNICARE/DORAL" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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