Provider Demographics
NPI:1700137619
Name:ARCH AIR MEDICAL SERVICE INC.
Entity Type:Organization
Organization Name:ARCH AIR MEDICAL SERVICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:KEENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-915-2301
Mailing Address - Street 1:621 CARNEGIE DR
Mailing Address - Street 2:STE 210
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3536
Mailing Address - Country:US
Mailing Address - Phone:909-915-2304
Mailing Address - Fax:402-952-2427
Practice Address - Street 1:1620 NEW PERRINE RD.
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-2061
Practice Address - Country:US
Practice Address - Phone:573-701-0147
Practice Address - Fax:576-747-0786
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARCH AIR MEDICAL SERVICE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-02
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO5100923416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000090010Medicare PIN