Executive Air Taxi Corp.

Primary specialty

Air AmbulanceTaxonomy code 3416A0800X

License

681 Issued in ND

Legal business name

EXECUTIVE AIR TAXI CORP.

Doing business as

Angel Air Care

Practice address

2301 University Dr
Bismarck, ND 58504-7595

Phone

(701) 321-1456

Fax

(701) 258-2693

NPI assigned

Feb 9, 2011

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 2

Addresses

Other identifiers 2

Other names 1

• Angel Air Care Doing business as

Locations

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

{
    "created_epoch": "1297209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331251200000",
    "number": "1881990745",
    "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": "701-321-1456",
            "fax_number": "701-258-2693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXECUTIVE AIR TAXI CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-09",
        "last_updated": "2012-03-09",
        "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": "681",
            "primary": true
        },
        {
            "code": "3416A0800X",
            "taxonomy_group": "",
            "desc": "Ambulance, Air Transport",
            "state": "SD",
            "license": "0982",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "54188",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1881990745",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Angel Air Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2012; 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.