Provider Demographics
NPI:1992938088
Name:AERO VISTA INC
Entity type:Organization
Organization Name:AERO VISTA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAROL
Authorized Official - Middle Name:S
Authorized Official - Last Name:WINCHESTER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:928-526-1112
Mailing Address - Street 1:611 N LEROUX ST STE 100
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3267
Mailing Address - Country:US
Mailing Address - Phone:928-526-1112
Mailing Address - Fax:928-714-9285
Practice Address - Street 1:611 N LEROUX ST STE 100
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3267
Practice Address - Country:US
Practice Address - Phone:928-526-1112
Practice Address - Fax:928-714-9285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-24
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37680207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty