Provider Demographics
NPI:1215174768
Name:COAST TO COAST AIR AMBULANCE, LLC
Entity type:Organization
Organization Name:COAST TO COAST AIR AMBULANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:A/R MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBYNN
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:LONGENBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:928-368-6646
Mailing Address - Street 1:943 S MAIN ST STE 6
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-3890
Mailing Address - Country:US
Mailing Address - Phone:928-368-6799
Mailing Address - Fax:928-368-8776
Practice Address - Street 1:3151 AIRPORT LOOP STE 2
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901
Practice Address - Country:US
Practice Address - Phone:928-368-6799
Practice Address - Fax:928-368-8776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-20
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport