Provider Demographics
NPI:1538668843
Name:AERATECH MEDICAL INC
Entity Type:Organization
Organization Name:AERATECH MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:L
Authorized Official - Last Name:NEELY
Authorized Official - Suffix:
Authorized Official - Credentials:RRT,
Authorized Official - Phone:330-722-1711
Mailing Address - Street 1:5355 W MINNESOTA ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46241-3817
Mailing Address - Country:US
Mailing Address - Phone:877-225-2234
Mailing Address - Fax:
Practice Address - Street 1:5355 W MINNESOTA ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-3817
Practice Address - Country:US
Practice Address - Phone:877-225-2234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AERATECH MEDICAL INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-02
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN69001408A332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300007801Medicaid