MEDICARE: EXTENDED CARE AIR THERAPY SYSTEMS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699771253
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXTENDED CARE AIR THERAPY SYSTEMS, INC

Provider Business Mailing Address
First Line	:	PO BOX 25
Second Line	:
City	:	ROSEVILLE
State	:	OH
Zip	:	43777-0025
Country	:	US
Telephone Number	:	740-697-0845
Fax Number	:	740-697-2392

Provider Business Practice Location Address
First Line	:	7165 PAYNE RD
Second Line	:
City	:	ROSEVILLE
State	:	OH
Zip	:	43777-9711
Country	:	US
Telephone Number	:	740-697-0845
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JERRY MAY
Credential	:
Telephone Number	:	740-607-0845

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	08/22/2020

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