1386837367 NPI number — LIFE FLIGHT NETWORK LLC

Table of content: (NPI 1386837367)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386837367 NPI number — LIFE FLIGHT NETWORK LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFE FLIGHT NETWORK LLC
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:
1386837367
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22285 YELLOW GATE LANE
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-678-4364
Provider Business Mailing Address Fax Number:
503-678-4369

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22285 YELLOW GATE LANE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-678-4364
Provider Business Practice Location Address Fax Number:
503-678-4369
Provider Enumeration Date:
08/22/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
OSBORNE
Authorized Official First Name:
ADAM
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
503-678-4364

Provider Taxonomy Codes

  • Taxonomy code: 3416A0800X , with the licence number:  2610 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3416A0800X , with the licence number: AIRV.ES.60019210 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416A0800X , with the licence number: 1036 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416A0800X , with the licence number: 909 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X , with the licence number: 2610 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X , with the licence number: AIRV.ES.60019210 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X , with the licence number: 1036 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X , with the licence number: 723 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 343900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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