Provider Demographics
NPI:1609374537
Name:EAST TEXAS AIR ONE LLC
Entity Type:Organization
Organization Name:EAST TEXAS AIR ONE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:PETROVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-296-3000
Mailing Address - Street 1:1 BURTON HILLS BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-6195
Mailing Address - Country:US
Mailing Address - Phone:800-811-4045
Mailing Address - Fax:615-296-6227
Practice Address - Street 1:1 BURTON HILLS BLVD STE 250
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-6195
Practice Address - Country:US
Practice Address - Phone:615-296-3000
Practice Address - Fax:615-296-6227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-25
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport