1598261224 NPI number — APOLLO MEDFLIGHT, LLC

Table of content: TASIA CAMPBELL (NPI 1689146847)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598261224 NPI number — APOLLO MEDFLIGHT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APOLLO MEDFLIGHT, 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:
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:
1598261224
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 63
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMARILLO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79105-0063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-242-9028
Provider Business Mailing Address Fax Number:
888-978-5029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
304 WRIGHT BROTHERS WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHLANDS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28574-6008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-322-4448
Provider Business Practice Location Address Fax Number:
888-978-5029
Provider Enumeration Date:
04/02/2018

Additional Information

Authorized Official

Authorized Official Last Name:
DORRIS
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
806-242-9028

Provider Taxonomy Codes

  • Taxonomy code: 3416A0800X , with the licence number:  3009 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1598261224 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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