Provider Demographics
NPI:1164811428
Name:THE INDEPENDENCE CENTER FOR HYPERBARICS AND WELLNESS
Entity Type:Organization
Organization Name:THE INDEPENDENCE CENTER FOR HYPERBARICS AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NATIONAL MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-222-1142
Mailing Address - Street 1:14330 OAKHILL LANE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078
Mailing Address - Country:US
Mailing Address - Phone:704-997-8146
Mailing Address - Fax:704-997-8125
Practice Address - Street 1:14330 OAKHILL LANE
Practice Address - Street 2:SUITE 140
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078
Practice Address - Country:US
Practice Address - Phone:704-997-8146
Practice Address - Fax:704-997-8125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center