Provider Demographics
NPI:1154408391
Name:CALIFORNIA SHOCK TRAUMA AIR RESCUE
Entity type:Organization
Organization Name:CALIFORNIA SHOCK TRAUMA AIR RESCUE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:F
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-921-4000
Mailing Address - Street 1:4933 BAILEY LOOP
Mailing Address - Street 2:
Mailing Address - City:MCCLELLAN
Mailing Address - State:CA
Mailing Address - Zip Code:95652
Mailing Address - Country:US
Mailing Address - Phone:916-921-4075
Mailing Address - Fax:916-921-4079
Practice Address - Street 1:4933 BAILEY LOOP
Practice Address - Street 2:
Practice Address - City:MCCLELLAN
Practice Address - State:CA
Practice Address - Zip Code:95652
Practice Address - Country:US
Practice Address - Phone:916-921-4075
Practice Address - Fax:916-921-4079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
STRA29013416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTA00592FMedicaid
CAMTA00592FMedicaid
ZZZ949812Medicare ID - Type UnspecifiedNORTHERN CALIFORNIA