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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