Provider Demographics
NPI:1851685630
Name:MOUNTAIN LIFEFLIGHT, INC.
Entity Type:Organization
Organization Name:MOUNTAIN LIFEFLIGHT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:CROSBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-257-0249
Mailing Address - Street 1:PO BOX 711
Mailing Address - Street 2:
Mailing Address - City:SUSANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96130-0711
Mailing Address - Country:US
Mailing Address - Phone:530-257-0249
Mailing Address - Fax:530-251-2998
Practice Address - Street 1:710 ASH ST
Practice Address - Street 2:
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96130-3716
Practice Address - Country:US
Practice Address - Phone:530-257-0249
Practice Address - Fax:530-251-2998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-08
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGB789AMedicaid