Provider Demographics
NPI:1518210962
Name:FAYETTEVILLE HYPERBARICS LLC
Entity Type:Organization
Organization Name:FAYETTEVILLE HYPERBARICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-920-1165
Mailing Address - Street 1:3035 BOONE TRAIL EXT STE A
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3860
Mailing Address - Country:US
Mailing Address - Phone:910-920-1165
Mailing Address - Fax:910-425-5178
Practice Address - Street 1:3035 BOONE TRAIL EXT STE A
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3860
Practice Address - Country:US
Practice Address - Phone:910-920-1165
Practice Address - Fax:910-425-5178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-23
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty