Basic Information
| Provider Information | |||||||||
| NPI: | 1922466598 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AERMED LOGISTIX LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1690 DUNLAWTON AVE | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | PORT ORANGE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321278979 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3868989801 | ||||||||
| FaxNumber: | 3863222095 | ||||||||
| Practice Location | |||||||||
| Address1: | 1455 E GOLF RD | ||||||||
| Address2: | |||||||||
| City: | DES PLAINES | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600161250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8473907666 | ||||||||
| FaxNumber: | 8473909345 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2016 | ||||||||
| LastUpdateDate: | 02/10/2016 | ||||||||
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| AuthorizedOfficialLastName: | IPPOLITO | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8477021530 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 036085385 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.