1427069962 NPI number — EAGLE AIR MED CORPORATION

Table of content: (NPI 1427069962)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427069962 NPI number — EAGLE AIR MED CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAGLE AIR MED CORPORATION
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:
6
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:
1427069962
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10888 S 300 W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH JORDAN
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84095-4043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-619-4900
Provider Business Mailing Address Fax Number:
801-619-8077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CHINLE MUNICIPAL AIRPORT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHINLE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-619-4900
Provider Business Practice Location Address Fax Number:
801-619-8077
Provider Enumeration Date:
08/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THOMAS
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
Authorized Official Title or Position:
SVP OF REVENUE MANAGEMENT
Authorized Official Telephone Number:
877-728-8534

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  06-0007 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416A0800X , with the licence number: AIR , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416A0800X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 19929323 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 387169 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 804717 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: R2833 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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