Provider Demographics
NPI:1154496651
Name:40 MILE AIR LTD
Entity Type:Organization
Organization Name:40 MILE AIR LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LEIF
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-883-5191
Mailing Address - Street 1:PO BOX 3510
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-3510
Mailing Address - Country:US
Mailing Address - Phone:360-394-7020
Mailing Address - Fax:360-394-7099
Practice Address - Street 1:1313 ALASKA HIGHWAY
Practice Address - Street 2:
Practice Address - City:TOK
Practice Address - State:AK
Practice Address - Zip Code:99780
Practice Address - Country:US
Practice Address - Phone:907-883-5191
Practice Address - Fax:907-883-5194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK83753416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1000152Medicaid
AKP01308364OtherRAILROAD MC
AK1000152Medicaid