Provider Demographics
NPI:1821054610
Name:MSE AIR GROUP INC
Entity Type:Organization
Organization Name:MSE AIR GROUP INC
Other - Org Name:AVIANE AIR AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-871-0207
Mailing Address - Street 1:PO BOX 1717
Mailing Address - Street 2:
Mailing Address - City:CIALES
Mailing Address - State:PR
Mailing Address - Zip Code:00638-1717
Mailing Address - Country:US
Mailing Address - Phone:787-871-0207
Mailing Address - Fax:787-871-4707
Practice Address - Street 1:HANGAR-AVIANE LOT D AT NORTH SIDE
Practice Address - Street 2:ISLA GRANDE AIRPORT
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-907-1585
Practice Address - Fax:787-907-1588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRS0420TCAMBA033416A0800X
PRTCAMB-(A)-033416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0056817Medicaid
PRTCAMB-(A)-03OtherLICENCE OF THE PR PUBLIC COMMISSION SERVICE
PR1821054610OtherNPI