Provider Demographics
NPI:1477846889
Name:MEDIVAC AIR RESCUE, INC.
Entity Type:Organization
Organization Name:MEDIVAC AIR RESCUE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:NREMT-P
Authorized Official - Phone:877-260-3575
Mailing Address - Street 1:5751 KROGER DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-5632
Mailing Address - Country:US
Mailing Address - Phone:877-260-3575
Mailing Address - Fax:877-514-2571
Practice Address - Street 1:5751 KROGER DR
Practice Address - Street 2:SUITE 230
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-5632
Practice Address - Country:US
Practice Address - Phone:877-260-3575
Practice Address - Fax:877-514-2571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport