Provider Demographics
NPI:1316949951
Name:AIR ANGELS INC
Entity type:Organization
Organization Name:AIR ANGELS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DERMONT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-876-7215
Mailing Address - Street 1:320 KRESS RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-1810
Mailing Address - Country:US
Mailing Address - Phone:630-876-7215
Mailing Address - Fax:630-876-7249
Practice Address - Street 1:320 KRESS RD
Practice Address - Street 2:
Practice Address - City:WEST CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60185-1810
Practice Address - Country:US
Practice Address - Phone:630-876-7215
Practice Address - Fax:630-876-7249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-12
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07343416A0800X
IL9 79643416L0300X
IL8 7964083416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILBLUE CROSS/BLUE SHIEOther2223078
ILBLUE CROSS/BLUE SHIEOther2223078
IN183910Medicare ID - Type UnspecifiedADMINISTAR FEDERAL
IL=========001Medicaid