Air Evac EMS, Inc.
Organization Active NPI Air Ambulance · Ardmore, OK
NPI 1679942270 · NPPES record last updated Sep 16, 2022
Key facts
- NPI
- 1679942270
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Air Ambulance 3416A0800X
- Legal business name
- AIR EVAC EMS, INC.
- Practice address
- 2205 Executive Airport Dr
Ardmore, OK 73401-2101 - Phone
- (877) 288-5340
- Fax
- (417) 257-5761
- NPI assigned
- Sep 24, 2015
- 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 19
Corporate family (same tax ID) 17
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 37D2102424 | Air Evac Lifeteam Air Evac #130 | Certificate of waiver | Sep 21, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040730001084 | OK | Part B Supplier - Ambulance Service Supplier | 8123931755 |
19 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Woodward, OK; Weatherford, OK; Seminole, OK; Ponca City, OK; Pauls Valley, OK; Muskogee, OK; Kingfisher, OK; Idabel, OK… |
National Provider Directory
- Tax ID family
- Lifeteam Midwest Ae20
- Part of
- Lifeteam Midwest Ae20
Locations
2205 Executive Airport Dr
Ardmore, OK 73401
Phone (580) 465-6130
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Air Ambulance | 3416A0800X | Yes |
Addresses
Primary practice location
2205 Executive Airport Dr
Ardmore, OK 73401-2101
Mailing address
PO Box 106
West Plains, MO 65775-0106
Other names
- Air Evac Lifeteam
Other providers in Ardmore, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 16, 2022. 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.