1770772584 NPI number — OMNIFLIGHT HELICOPTERS, INC

Table of content: (NPI 1770772584)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770772584 NPI number — OMNIFLIGHT HELICOPTERS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OMNIFLIGHT HELICOPTERS, 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:
Provider Other Organization Name Type Code:
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:
1770772584
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6402 E SUPERSTITION SPRINGS BLVD
Provider Second Line Business Mailing Address:
STE 224
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85206-4392
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-988-3840
Provider Business Mailing Address Fax Number:
480-988-3843

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2827 W DUBLIN GRANVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43235-2712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-734-8044
Provider Business Practice Location Address Fax Number:
614-734-8078
Provider Enumeration Date:
10/17/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
REDMOND
Authorized Official First Name:
MARNIE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
ASSISTANT DIRECTOR
Authorized Official Telephone Number:
480-988-3840

Provider Taxonomy Codes

  • Taxonomy code: 3416A0800X , with the licence number:  25-405-3 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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