MED FLIGHT AIR AMBULANCE INC

Provider Demographics

• NPI: 1952307126
• Name: MED FLIGHT AIR AMBULANCE INC
• Entity Type: Organization
• Organization Name: MED FLIGHT AIR AMBULANCE INC
• Authorized Official - Title/Position: CEO
• Authorized Official - Prefix: DR
• Authorized Official - First Name: LARRY
• Authorized Official - Middle Name: D
• Authorized Official - Last Name: LEVY
• Authorized Official - Credentials: MD
• Authorized Official - Phone: 505-842-4433
• Mailing Address - Street 1: 2301 YALE BLVD SE
• Mailing Address - Street 2: STE D3
• Mailing Address - City: ALBUQUERQUE
• Mailing Address - State: NM
• Mailing Address - Zip Code: 87106-4355
• Mailing Address - Country: US
• Mailing Address - Phone: 505-842-4433
• Mailing Address - Fax: 505-842-4436
• Practice Address - Street 1: 2301 YALE BLVD SE
• Practice Address - Street 2: STE D3
• Practice Address - City: ALBUQUERQUE
• Practice Address - State: NM
• Practice Address - Zip Code: 87106-4355
• Practice Address - Country: US
• Practice Address - Phone: 505-842-4433
• Practice Address - Fax: 505-842-4436
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2005-06-22
• Last Update Date: 2018-08-17

Provider Licenses

State	License ID	Taxonomies
NM	F00010	3416A0800X
TX	071005	3416A0800X
UT	2927L	3416A0800X
NV	3430	3416A0800X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	3416A0800X	Transportation Services	Ambulance	Air Transport

Provider Identifiers

State	Identifier ID	ID Type	Issuer
NV	0032-02300	Medicaid
KS	ME578959	Medicaid
NM	R1157	Medicaid
CA	XMTA05973	Medicaid
TX	0733404-01	Medicaid
AZ	804585	Medicaid
CO	96001474	Medicaid
CA	XMTA05973	Medicaid
TX	0733404-01	Medicaid
NM	2507798	Medicare ID - Type Unspecified
OK	=========4	Medicaid
CO	96001474	Medicaid
NV	0032-02300	Medicaid
AZ	RFBHW	Medicare ID - Type Unspecified
CA	Z522	Medicare ID - Type Unspecified	SOUTH
KS	130305	Medicare ID - Type Unspecified
TX	0733404-01	Medicaid