| Name | Value |
|---|---|
| PROVIDER TYPE | Transportation Services |
| CLASSIFICATION | Ambulance |
| AREA OF SPECIALIZATION | Air Transport |
| STATUS | Active |
| X12 CODE | 3416A0800X |
| SPECIALTY CODE | 59 |
| INDIVIDUAL/NON | NON-INDIVIDUAL |
| MASTER ENTRY FOR VUID | YES |
| VUID | 5255972 |
| EFFECTIVE DATE/TIME |
|