Provider Demographics
NPI:1275000283
Name:SAINT PAUL HYPERBARIC OXYGEN CENTER, P.A
Entity Type:Organization
Organization Name:SAINT PAUL HYPERBARIC OXYGEN CENTER, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:612-799-7833
Mailing Address - Street 1:2151 HAMLINE AVE N STE 111B
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-4226
Mailing Address - Country:US
Mailing Address - Phone:612-799-7833
Mailing Address - Fax:
Practice Address - Street 1:2151 HAMLINE AVE N STE 111B
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-4226
Practice Address - Country:US
Practice Address - Phone:612-799-7833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center