Provider Demographics
NPI:1114462108
Name:EXPRESS AIR MEDICAL TRANSPORT, LLC
Entity Type:Organization
Organization Name:EXPRESS AIR MEDICAL TRANSPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-304-8094
Mailing Address - Street 1:200 2ND AVE S
Mailing Address - Street 2:506
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4313
Mailing Address - Country:US
Mailing Address - Phone:800-304-8094
Mailing Address - Fax:866-596-4830
Practice Address - Street 1:200 2ND AVE S
Practice Address - Street 2:506
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4313
Practice Address - Country:US
Practice Address - Phone:800-304-8094
Practice Address - Fax:866-596-4830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6223416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009139100Medicaid