Healthcare Provider Details

I. General information

NPI: 1699771253
Provider Name (Legal Business Name): EXTENDED CARE AIR THERAPY SYSTEMS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7165 PAYNE RD
ROSEVILLE OH
43777-9711
US

IV. Provider business mailing address

PO BOX 25
ROSEVILLE OH
43777-0025
US

V. Phone/Fax

Practice location:
  • Phone: 740-697-0845
  • Fax:
Mailing address:
  • Phone: 740-697-0845
  • Fax: 740-697-2392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JERRY MAY
Title or Position: PRESIDENT
Credential:
Phone: 740-607-0845