| Organization Name: | EAGLEMED LLC |
| NPI Number: | 1164862165 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ERIC THOMAS (SVP OF REVENUE MANAGEMENT) |
| Mailing Address: | 9025 4th St Gbd Airport Great Bend |
| State: | KS US |
| Postal Code: | 675309767 |
| Phone Number: | 4172571585 |
| Fax Number: | 4172575761 |
| NPI Enumeration Date: | 07/05/2013 |
| NPI Last Update Date: | 04/07/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3416L0300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Transportation Services |
| Taxonomy Classification: | Ambulance |
| Taxonomy Specialization: | Land Transport |
| Taxonomy Definition: | |