Provider Demographics
NPI:1760415137
Name:AIRSTATION TRAVERSE CITY
Entity Type:Organization
Organization Name:AIRSTATION TRAVERSE CITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HS3
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELVIRA
Authorized Official - Middle Name:FABIOLA
Authorized Official - Last Name:LOMBARDO
Authorized Official - Suffix:
Authorized Official - Credentials:HEALTH SERVICES TECH
Authorized Official - Phone:231-922-8282
Mailing Address - Street 1:2012 E FRONT ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-3023
Mailing Address - Country:US
Mailing Address - Phone:231-631-4660
Mailing Address - Fax:231-922-8292
Practice Address - Street 1:1175 AIRPORT ACCESS RD
Practice Address - Street 2:FLIGHT MED CLINIC
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3513
Practice Address - Country:US
Practice Address - Phone:231-922-8282
Practice Address - Fax:231-922-8292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45189021302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization