Provider Demographics
NPI:1013294982
Name:AERO MED, LLC
Entity Type:Organization
Organization Name:AERO MED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUSS
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-579-8171
Mailing Address - Street 1:PO BOX 150003
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74115-0003
Mailing Address - Country:US
Mailing Address - Phone:520-579-8171
Mailing Address - Fax:520-579-3515
Practice Address - Street 1:7601 E APACHE ST HNGR 22
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74115-3721
Practice Address - Country:US
Practice Address - Phone:520-579-8171
Practice Address - Fax:520-579-3515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKEMS2903416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ533193Medicaid
OKOKB5987OtherOK MEDICARE
AZZ140448OtherAZ MEDICARE
OK100819320AMedicaid
OK200298930AMedicaid
NMB2466OtherNM MEDICARE