Provider Demographics
NPI:1972892297
Name:LATITUDE AEROMEDICAL INTERNATIONAL INC
Entity Type:Organization
Organization Name:LATITUDE AEROMEDICAL INTERNATIONAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCINTOSH
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:289-921-6241
Mailing Address - Street 1:7250 STAR CHECK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43217-1025
Mailing Address - Country:US
Mailing Address - Phone:888-693-1440
Mailing Address - Fax:
Practice Address - Street 1:7250 STAR CHECK DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43217-1025
Practice Address - Country:US
Practice Address - Phone:614-409-2720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH19821563416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH254053OtherOHIO MEDCIAL TRANSPORTATION BOARD
OHEMS 022105450-13OtherOHIO STATE BOARD OF PHARMACY
ML2343010OtherDEA CERTIFICATE
ML2343010OtherDEA CERTIFICATE