Healthcare Provider Details

I. General information

NPI: 1487764817
Provider Name (Legal Business Name): AERO MED INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 06/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 E APACHE ST
TULSA OK
74115-3721
US

IV. Provider business mailing address

PO BOX 150003
TULSA OK
74115-0003
US

V. Phone/Fax

Practice location:
  • Phone: 520-579-8171
  • Fax: 520-579-3515
Mailing address:
  • Phone: 520-579-8171
  • Fax: 520-579-3515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License Number
License Number State

VIII. Authorized Official

Name: RUSS NEWMAN
Title or Position: PRESIDENT
Credential:
Phone: 520-579-8171