Provider Demographics
NPI:1982687794
Name:AIR EVAC EMS INC
Entity Type:Organization
Organization Name:AIR EVAC EMS INC
Other - Org Name:AIR EVAC LIFETEAM
Other - Org Type:Doing Business As
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 106
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-0106
Mailing Address - Country:US
Mailing Address - Phone:877-288-5340
Mailing Address - Fax:
Practice Address - Street 1:2702 S 13TH ST
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533
Practice Address - Country:US
Practice Address - Phone:417-257-1585
Practice Address - Fax:417-257-5761
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AIR EVAC EMS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-25
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3416A0800X
OKEMS4013416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AEL-025 LAWTONOtherBASE ID