Active NPI
40 Mile Air LTD
- Air Ambulance
- Tok, AK
National Provider Identifier
1154496651
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Air Ambulance
- License
- 8375
- Legal business name
- 40 MILE AIR LTD
- Practice address
- 1313 Alaska Highway
Tok, AK 99780 - Phone
- (907) 883-5191
- Fax
- (907) 883-5194
- NPI assigned
- Nov 21, 2006
- Last updated
- Dec 17, 2014
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Leif Wilson
- Title
- Owner-President
- Phone
- (907) 883-5191
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Air Ambulance | 3416A0800X | 8375 | AK | Primary |
Addresses
Primary practice location
1313 Alaska Highway
Tok, AK 99780
Mailing address
PO Box 3510
Silverdale, WA 98383-3510
Phone (360) 394-7020
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P01308364 | Other | AK | RAILROAD MC |
| 1000152 | Medicaid | AK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AK
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100421000262 | AK | Part B Supplier - Ambulance Service Supplier | 2466589510 | Practice locations: Tok, AK |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164067200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1418774400000",
"number": "1154496651",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3510",
"city": "SILVERDALE",
"state": "WA",
"postal_code": "983833510",
"telephone_number": "360-394-7020",
"fax_number": "360-394-7099"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1313 ALASKA HIGHWAY",
"city": "TOK",
"state": "AK",
"postal_code": "99780",
"telephone_number": "907-883-5191",
"fax_number": "907-883-5194"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "40 MILE AIR LTD",
"organizational_subpart": "NO",
"enumeration_date": "2006-11-21",
"last_updated": "2014-12-17",
"status": "A",
"authorized_official_last_name": "WILSON",
"authorized_official_first_name": "LEIF",
"authorized_official_title_or_position": "OWNER-PRESIDENT",
"authorized_official_telephone_number": "907-883-5191",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "3416A0800X",
"taxonomy_group": "",
"desc": "Ambulance, Air Transport",
"state": "AK",
"license": "8375",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MC",
"identifier": "P01308364",
"state": "AK"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1000152",
"state": "AK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tok, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.