1508813379 NPI number — TRI STATE CARE FLIGHT, LLC

Table of content: (NPI 1508813379)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508813379 NPI number — TRI STATE CARE FLIGHT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRI STATE CARE FLIGHT, 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:
1508813379
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 398074
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94139-8074
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-711-4045
Provider Business Mailing Address Fax Number:
707-571-2362

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5500 S QUEBEC ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENWOOD VILLAGE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80111-1914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-792-7400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GORDON
Authorized Official First Name:
CRYSTAL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
303-881-8921

Provider Taxonomy Codes

  • Taxonomy code: 3416A0800X , with the licence number:  A014 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 804840 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 88923266 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1012986950001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: XMTA05997 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: XMTA01147F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200489880A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: XMTA06005 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100502776 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 91622361 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0044547 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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