Provider Demographics
NPI:1043562176
Name:EAGLE MED GROUP, LLC
Entity Type:Organization
Organization Name:EAGLE MED GROUP, LLC
Other - Org Name:EAGLE MED FLIGHT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:480-526-5378
Mailing Address - Street 1:2575 E CAMELBACK RD
Mailing Address - Street 2:SUITE 450
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4240
Mailing Address - Country:US
Mailing Address - Phone:480-526-5378
Mailing Address - Fax:480-526-5379
Practice Address - Street 1:2575 E CAMELBACK RD
Practice Address - Street 2:SUITE 450
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4240
Practice Address - Country:US
Practice Address - Phone:480-526-5378
Practice Address - Fax:480-526-5379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-13
Last Update Date:2012-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport