Healthcare Provider Details

I. General information

NPI: 1568345379
Provider Name (Legal Business Name): AEROMIND SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2025
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 N STADIUM BLVD FL 2
COLUMBIA MO
65203-1493
US

IV. Provider business mailing address

115 CONLEY RD STE 1008
COLUMBIA MO
65201-6465
US

V. Phone/Fax

Practice location:
  • Phone: 573-577-3415
  • Fax:
Mailing address:
  • Phone: 573-577-3415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: IBRAHIM M ABUMUNYE
Title or Position: MANAGING PARTNER
Credential:
Phone: 612-481-0934