Provider Demographics
NPI:1003855446
Name:CLASSIC AIR CARE INC
Entity Type:Organization
Organization Name:CLASSIC AIR CARE INC
Other - Org Name:CLASSIC LIFEGUARD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:ERIKO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-295-5700
Mailing Address - Street 1:2244 SOUTH 1640 WEST
Mailing Address - Street 2:
Mailing Address - City:WOODS CROSS
Mailing Address - State:UT
Mailing Address - Zip Code:84087
Mailing Address - Country:US
Mailing Address - Phone:801-295-5700
Mailing Address - Fax:801-443-1993
Practice Address - Street 1:2244 SOUTH 1640 WEST
Practice Address - Street 2:
Practice Address - City:WOODS CROSS
Practice Address - State:UT
Practice Address - Zip Code:84087
Practice Address - Country:US
Practice Address - Phone:801-295-5700
Practice Address - Fax:801-649-0963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3003L3416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0152510OtherBLUE CROSS BLUE SHIELD
AZ897986Medicaid
AZ897986Medicaid
AZAZ0152510OtherBLUE CROSS BLUE SHIELD
NVV101568Medicare PIN
UT000090811Medicare PIN