Provider Demographics
NPI:1770663056
Name:EAST TEXAS FLIGHT AMBULANCE
Entity Type:Organization
Organization Name:EAST TEXAS FLIGHT AMBULANCE
Other - Org Name:AIR ONE EAST TEXAS MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR AIR ONE
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:K
Authorized Official - Last Name:ROWDEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:903-531-8285
Mailing Address - Street 1:PO BOX 6838
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75711-6838
Mailing Address - Country:US
Mailing Address - Phone:903-531-8285
Mailing Address - Fax:903-596-3298
Practice Address - Street 1:1000 S BECKHAM AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1908
Practice Address - Country:US
Practice Address - Phone:903-531-8285
Practice Address - Fax:903-596-3298
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST TEXAS MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-17
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2120223416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX020812602Medicaid
TXAMB014OtherBC/BS
TX152677FYOtherPREFERRED CARE
TX751803325OtherTRICARE
TXAMB014OtherBC/BS
TXAMB014Medicare ID - Type Unspecified
TX751803325OtherTRICARE
TX590012722Medicare ID - Type UnspecifiedRAILROAD MEDICARE