Provider Demographics
NPI:1437919107
Name:H2OASIS INFUSION AND WELLNESS CLINIC
Entity Type:Organization
Organization Name:H2OASIS INFUSION AND WELLNESS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:SHAGOOFA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAMANI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:812-826-4492
Mailing Address - Street 1:421 E 3RD ST STE 7
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-3674
Mailing Address - Country:US
Mailing Address - Phone:812-826-4492
Mailing Address - Fax:888-804-5420
Practice Address - Street 1:421 E 3RD ST STE 7
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-3674
Practice Address - Country:US
Practice Address - Phone:812-826-4492
Practice Address - Fax:888-804-5420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-20
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy