Provider Demographics
NPI:1841243284
Name:EAGLE AIR MED
Entity Type:Organization
Organization Name:EAGLE AIR MED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP OF REVENUE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:877-288-5340
Mailing Address - Street 1:212 FREEDOM WAY
Mailing Address - Street 2:
Mailing Address - City:BLANDING
Mailing Address - State:UT
Mailing Address - Zip Code:84511-3248
Mailing Address - Country:US
Mailing Address - Phone:435-678-3222
Mailing Address - Fax:435-678-3425
Practice Address - Street 1:212 FREEDOM WAY
Practice Address - Street 2:
Practice Address - City:BLANDING
Practice Address - State:UT
Practice Address - Zip Code:84511-3248
Practice Address - Country:US
Practice Address - Phone:435-678-3222
Practice Address - Fax:435-678-3425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1090L3416A0800X
AZ06-0073416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ387169Medicaid