Provider Demographics
NPI:1508813379
Name:TRI STATE CARE FLIGHT, LLC
Entity Type:Organization
Organization Name:TRI STATE CARE FLIGHT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-881-8921
Mailing Address - Street 1:PO BOX 398074
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94139-8074
Mailing Address - Country:US
Mailing Address - Phone:800-711-4045
Mailing Address - Fax:707-571-2362
Practice Address - Street 1:5500 S QUEBEC ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-1914
Practice Address - Country:US
Practice Address - Phone:303-792-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COA0143416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ804840Medicaid
NM88923266Medicaid
PA1012986950001Medicaid
CAXMTA05997Medicaid
CAXMTA01147FMedicaid
IN200489880AMedicaid
CAXMTA06005Medicaid
NV100502776Medicaid
CO91622361Medicaid
NJ0044547Medicaid
NM300521048Medicare PIN
AZP00076905Medicare PIN
COC532058Medicare PIN
NV100502776Medicaid
NM88923266Medicaid