Provider Demographics
NPI:1366692931
Name:AERIS HEALTHCARE, LLC
Entity type:Organization
Organization Name:AERIS HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:MAYS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-560-0003
Mailing Address - Street 1:117 CENTER PARK DR
Mailing Address - Street 2:SUITE305
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-2131
Mailing Address - Country:US
Mailing Address - Phone:865-560-0003
Mailing Address - Fax:
Practice Address - Street 1:117 CENTER PARK DR
Practice Address - Street 2:SUITE305
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-2131
Practice Address - Country:US
Practice Address - Phone:865-560-0003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6289400001Medicare NSC