Organization
GALLUP MED FLIGHT, LLC
Active
Other names
Gallup Med Flight
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ERIC THOMAS (SVP OF REVENUE MANAGEMENT)
(877) 288-5340
Entity
Organization
Contact information
Practice address
2111 W HISTORIC HIGHWAY 66, GALLUP, NM 87301
(801) 619-4900
(801) 619-8077
Mailing address
10888 S 300 W, SOUTH JORDAN, UT 84095-4043
(801) 619-4900
(801) 619-8077
Taxonomy
Speciality
Code
Description
License number
State
3416A0800X
Air Ambulance
Primary
06-00000788
NM
3416L0300X
Land Ambulance
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0551606
—
IA
05
—
06023803
—
MI
01
—
800185
FEDERAL BLACK LUNG PROGRA
—
05
—
804824
—
AZ
05
—
93272839
—
CO
05
—
G1735
—
NM
01
—
RB48
BC'BS OF NM PROVIDER #
NM
05
—
XMTA05996
—
CA
Enumeration date
08/18/2006
Last updated
08/03/2018
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