Provider Demographics
NPI:1992818645
Name:DESERT AIR AMBULANCE INC
Entity type:Organization
Organization Name:DESERT AIR AMBULANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:DAVIS-SARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:760-922-5911
Mailing Address - Street 1:PO BOX 796
Mailing Address - Street 2:
Mailing Address - City:BLYTHE
Mailing Address - State:CA
Mailing Address - Zip Code:92226-0796
Mailing Address - Country:US
Mailing Address - Phone:760-922-5911
Mailing Address - Fax:760-922-5912
Practice Address - Street 1:140 N. BROADWAY DR.
Practice Address - Street 2:
Practice Address - City:BLYTHE
Practice Address - State:CA
Practice Address - Zip Code:92225-1608
Practice Address - Country:US
Practice Address - Phone:760-922-5911
Practice Address - Fax:760-922-5912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAU7ZA454L3416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ913708Medicaid
CAMTA01168FMedicaid
AZ913708Medicaid
CAZA550Medicare PIN