Provider Demographics
NPI:1275680472
Name:HYPERBARIC MEDICINE CENTER
Entity Type:Organization
Organization Name:HYPERBARIC MEDICINE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:MC CRACKEN
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:808-851-7030
Mailing Address - Street 1:275 PUUHALE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-2237
Mailing Address - Country:US
Mailing Address - Phone:808-851-7030
Mailing Address - Fax:808-851-7031
Practice Address - Street 1:275 PUUHALE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-2237
Practice Address - Country:US
Practice Address - Phone:808-851-7030
Practice Address - Fax:808-851-7031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI585648-01Medicaid