Air Evac EMS, Inc.
Organization Active NPI Air Ambulance · Olney, IL
NPI 1104338425 · NPPES record last updated Sep 26, 2018
Key facts
- NPI
- 1104338425
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Air Ambulance 3416A0800X
- Legal business name
- AIR EVAC EMS, INC.
- Practice address
- 3666 N Il 130
Olney, IL 62450-4741 - Phone
- (877) 288-5340
- Fax
- (417) 257-5761
- NPI assigned
- Oct 26, 2017
- Organization subpart
- Yes
- Parent organization (as reported)
- AIR EVAC EMS, INC.
Authorized official
- Name
- Eric Thomas
- Title
- SVP of Revenue Management
- Phone
- (877) 288-5340
Other NPIs on the same Medicare enrollment 13
Corporate family (same tax ID) 12
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 14D2147345 | Air Evac Lifeteam - Ael 150 Olney Il | Certificate of waiver | Apr 16, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040310000107 | IL | Part B Supplier - Ambulance Service Supplier | 8123931755 |
13 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Mount Vernon, IL; Watson, IL; Quincy, IL; Olney, IL; Mattoon, IL; Marion, IL; Maryville, IL; Greenville, IL… |
National Provider Directory
- Tax ID family
- Lifeteam Midwest Ae20
- Part of
- Lifeteam Midwest Ae20
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Air Ambulance | 3416A0800X | Yes |
Addresses
Primary practice location
3666 N Il 130
Olney, IL 62450-4741
Mailing address
PO Box 106
West Plains, MO 65775-0106
Phone (877) 288-5340
Other names
- Air Evac Lifeteam
Other providers in Olney, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 26, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.