Provider Demographics
NPI:1093389975
Name:HYDRO INFUSIONS, LLC
Entity Type:Organization
Organization Name:HYDRO INFUSIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFORDS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:904-567-3998
Mailing Address - Street 1:11 GRAY WOLF TRL
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-6052
Mailing Address - Country:US
Mailing Address - Phone:904-567-3998
Mailing Address - Fax:904-567-5790
Practice Address - Street 1:14797 PHILIPS HWY STE 201
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-3746
Practice Address - Country:US
Practice Address - Phone:904-567-3998
Practice Address - Fax:904-567-5790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-16
Last Update Date:2021-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center