Executive Air Taxi Corp.

Primary specialty

Air AmbulanceTaxonomy code 3416A0800X

License

CTYA019D Issued in ND

Legal business name

EXECUTIVE AIR TAXI CORP.

Practice address

2301 University Dr
Bismarck, ND 58504-7595

Phone

(701) 258-5024

Fax

(701) 258-2693

NPI assigned

Jan 14, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Callen Cermak

Title

Cfo

Phone

(701) 258-5024

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1263427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1269475200000",
    "number": "1548591506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 UNIVERSITY DR",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585047595",
            "telephone_number": "701-258-5024",
            "fax_number": "701-258-2693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 UNIVERSITY DR",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585047595",
            "telephone_number": "701-258-5024",
            "fax_number": "701-258-2693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXECUTIVE AIR TAXI CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-14",
        "last_updated": "2010-03-25",
        "status": "A",
        "authorized_official_last_name": "CERMAK",
        "authorized_official_first_name": "CALLEN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "701-258-5024"
    },
    "taxonomies": [
        {
            "code": "3416A0800X",
            "taxonomy_group": "",
            "desc": "Ambulance, Air Transport",
            "state": "ND",
            "license": "CTYA019D",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "54188",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Miranda K Evanson, OTR/L
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• Air Ambulance in Bismarck, ND
• Providers in Bismarck, ND by specialty
• Air Ambulance in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.