1326482712 NPI number — CLASSIC AIR CARE LLC

Table of content: (NPI 1326482712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326482712 NPI number — CLASSIC AIR CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLASSIC AIR CARE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CLASSIC LIFEGUARD
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326482712
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5373 S GREEN ST STE 500
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURRAY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84123-4680
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-295-5700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2399 OXFORD WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STEAMBOAT SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80487-4991
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-295-5700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/29/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GARAY-CARSON
Authorized Official First Name:
MIGUEL
Authorized Official Middle Name:
Authorized Official Title or Position:
REVENUE CYCLE MANAGER
Authorized Official Telephone Number:
385-297-3381

Provider Taxonomy Codes

  • Taxonomy code: 3416A0800X , with the licence number:  3003L , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)