Provider Demographics
NPI:1427069962
Name:EAGLE AIR MED CORPORATION
Entity type:Organization
Organization Name:EAGLE AIR MED CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SVP OF REVENUE MANAGEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-728-8534
Mailing Address - Street 1:10888 S 300 W
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-4043
Mailing Address - Country:US
Mailing Address - Phone:801-619-4900
Mailing Address - Fax:801-619-8077
Practice Address - Street 1:CHINLE MUNICIPAL AIRPORT
Practice Address - Street 2:
Practice Address - City:CHINLE
Practice Address - State:AZ
Practice Address - Zip Code:86503
Practice Address - Country:US
Practice Address - Phone:801-619-4900
Practice Address - Fax:801-619-8077
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAGLE AIR MED CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-10
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAIR3416A0800X
AZ3416A0800X
AZ06-00073416L0300X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO19929323Medicaid
AZ387169Medicaid
AZ804717Medicaid
NMR2833Medicaid
AZZ78883Medicare ID - Type UnspecifiedPROVIDER ID NUMBER
AZ387169Medicaid
CO19929323Medicaid
COC805369Medicare ID - Type UnspecifiedCOLORADO MEDICARE