Provider Demographics
NPI:1578609418
Name:GATEWAY AIR AMBULANCE INC.
Entity Type:Organization
Organization Name:GATEWAY AIR AMBULANCE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-663-5535
Mailing Address - Street 1:P.O. BOX 26785
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66225-6785
Mailing Address - Country:US
Mailing Address - Phone:913-663-5535
Mailing Address - Fax:913-663-1503
Practice Address - Street 1:60 E. RIO SALADO PARKWAY
Practice Address - Street 2:SUITE 900
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281
Practice Address - Country:US
Practice Address - Phone:913-663-5535
Practice Address - Fax:913-663-1503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ06-00093416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ184638Medicaid