Provider Demographics
NPI:1861753915
Name:AERO ON-SITE IMAGING, CORP.
Entity type:Organization
Organization Name:AERO ON-SITE IMAGING, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/SONOGRAPHER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:ARDMS
Authorized Official - Phone:269-838-5865
Mailing Address - Street 1:7769 WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ODESSA
Mailing Address - State:MI
Mailing Address - Zip Code:48849-9323
Mailing Address - Country:US
Mailing Address - Phone:269-838-5865
Mailing Address - Fax:
Practice Address - Street 1:7769 WOODLAND RD
Practice Address - Street 2:
Practice Address - City:LAKE ODESSA
Practice Address - State:MI
Practice Address - Zip Code:48849-9323
Practice Address - Country:US
Practice Address - Phone:269-838-5865
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2471V0105X
MI1323942471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular SonographyGroup - Single Specialty