Provider Demographics
NPI:1306851845
Name:ENCHANTMENT AVIATION, INC.
Entity Type:Organization
Organization Name:ENCHANTMENT AVIATION, INC.
Other - Org Name:SOUTHWEST MED EVAC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT DIRECTOR OF PFS
Authorized Official - Prefix:MS
Authorized Official - First Name:MARNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:REDMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-760-1583
Mailing Address - Street 1:PO BOX 6119
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85216-6119
Mailing Address - Country:US
Mailing Address - Phone:800-760-1583
Mailing Address - Fax:480-988-3843
Practice Address - Street 1:670 WINGSPAN HNGR 2
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88007-9007
Practice Address - Country:US
Practice Address - Phone:505-525-2660
Practice Address - Fax:505-525-2610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0783862-01Medicaid
NMH3777Medicaid
TXP00217569Medicare PIN
NM590015188Medicare PIN
TX528237Medicare ID - Type UnspecifiedTEXAS PROVIDER NUMBER