Organization
MEMPHIS MEDICAL CENTER AIR AMBULANCE SERVICE, INC.
Active
Organization
MEMPHIS MEDICAL CENTER AIR AMBULANCE SERVICE, INC.
Active
Other names
Hospital Wing
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN A. BUTORA JR. (CEO)
(901) 522-5321
Entity
Organization
Contact information
Practice address
1080 EASTMORELAND AVE, MEMPHIS, TN 38104-3327
(901) 522-5321
Mailing address
P.O. BOX 205149, DALLAS, TX 75320-5149
(901) 522-5321
Taxonomy
Speciality
Code
Description
License number
State
3416A0800X
Air Ambulance
Primary
EMS0000009906
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00553958
—
MS
01
—
132775
TENNCARE BETTER HEALTH
TN
05
—
148123715
—
AR
05
—
160813501
—
TX
01
—
22924
TLC
TN
05
—
3574476
—
TN
01
—
4043897
BC/BS
TN
05
—
5500075600
—
KY
01
—
55982
TENNCARE OMNICARE/DORAL
TN
05
—
805962206
—
MO
Enumeration date
09/16/2006
Last updated
01/27/2015
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