Provider Demographics
NPI:1396194627
Name:PROFESSIONAL AIR AMBULANCE
Entity Type:Organization
Organization Name:PROFESSIONAL AIR AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANNY
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:SALGADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-261-1716
Mailing Address - Street 1:18818 N 62ND DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-7647
Mailing Address - Country:US
Mailing Address - Phone:623-261-1716
Mailing Address - Fax:
Practice Address - Street 1:18818 N 62ND DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-7647
Practice Address - Country:US
Practice Address - Phone:623-261-1716
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport