Provider Demographics
NPI:1871861211
Name:EAGLEMED LLC
Entity Type:Organization
Organization Name:EAGLEMED LLC
Other - Org Name:EAGLEMED 28
Other - Org Type:Other Name
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:
Authorized Official - Credentials:
Authorized Official - Phone:877-288-5340
Mailing Address - Street 1:PO BOX 108
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-0108
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:552 PERIMETER RD # A-5
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-5449
Practice Address - Country:US
Practice Address - Phone:877-288-5340
Practice Address - Fax:888-777-7413
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAGLEMED LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-13
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport