1821054610 NPI number — MSE AIR GROUP INC

Table of content: (NPI 1821054610)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821054610 NPI number — MSE AIR GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MSE AIR GROUP INC
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:
AVIANE AIR AMBULANCE
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:
1821054610
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1717
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CIALES
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00638-1717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-871-0207
Provider Business Mailing Address Fax Number:
787-871-4707

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HANGAR-AVIANE LOT D AT NORTH SIDE
Provider Second Line Business Practice Location Address:
ISLA GRANDE AIRPORT
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-907-1585
Provider Business Practice Location Address Fax Number:
787-907-1588
Provider Enumeration Date:
04/21/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CARRO
Authorized Official First Name:
JUAN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-871-0207

Provider Taxonomy Codes

  • Taxonomy code: 3416A0800X , with the licence number:  S0420TCAMBA03 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416A0800X , with the licence number: TCAMB-(A)-03 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0056817 , issued by the state of ( PR ) . This identifiers is of the category "MEDICAID".
  • Identifier: TCAMB-(A)-03 . This is a "LICENCE OF THE PR PUBLIC COMMISSION SERVICE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1821054610 . This is a "NPI" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".