Provider Demographics
NPI:1265749055
Name:WESTERN STATES AIR MEDICAL LLC
Entity type:Organization
Organization Name:WESTERN STATES AIR MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-757-6482
Mailing Address - Street 1:6565 AMERICAS PKWY NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-8116
Mailing Address - Country:US
Mailing Address - Phone:575-937-4040
Mailing Address - Fax:
Practice Address - Street 1:1000 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-9415
Practice Address - Country:US
Practice Address - Phone:575-937-4040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport