1558595157 NPI number — AEROSOL PLUS, INC.

Table of content: (NPI 1558595157)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558595157 NPI number — AEROSOL PLUS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AEROSOL PLUS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558595157
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
792 FOLLY RD
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
CHARLESTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29412-3476
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-408-4307
Provider Business Mailing Address Fax Number:
866-489-2738

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19295 N 3RD ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
COVINGTON
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70433-8897
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-231-5225
Provider Business Practice Location Address Fax Number:
866-945-5380
Provider Enumeration Date:
05/11/2009

Additional Information

Authorized Official

Authorized Official Last Name:
GUTMANN
Authorized Official First Name:
WERNER
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
877-795-6452

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1823724 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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