Provider Demographics
NPI:1083171342
Name:AER MEDICAL LLC
Entity Type:Organization
Organization Name:AER MEDICAL LLC
Other - Org Name:AER MEDICAL, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-313-8411
Mailing Address - Street 1:PO BOX 3627
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-3627
Mailing Address - Country:US
Mailing Address - Phone:907-262-4278
Mailing Address - Fax:907-802-4530
Practice Address - Street 1:1200 AIRPORT HEIGHTS DR STE 200
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2969
Practice Address - Country:US
Practice Address - Phone:907-262-4278
Practice Address - Fax:907-802-4530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-22
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1112393OtherSTATE BUSINESS LICENSE