Provider Demographics
NPI:1568410686
Name:MOBILE HYPERBARIC CENTERS, LLC
Entity Type:Organization
Organization Name:MOBILE HYPERBARIC CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:R
Authorized Official - Last Name:COWAP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-443-0430
Mailing Address - Street 1:600 SUPERIOR AVE E STE 2400
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114-2691
Mailing Address - Country:US
Mailing Address - Phone:216-443-0430
Mailing Address - Fax:216-443-0435
Practice Address - Street 1:600 SUPERIOR AVE E STE 2400
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-2691
Practice Address - Country:US
Practice Address - Phone:216-443-0430
Practice Address - Fax:216-443-0435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2645034Medicaid
OH000000354983OtherANTHEMBCBS
TN3370106Medicare PIN
OHDD3878Medicare PIN
OHMO9347111Medicare PIN
NYBA1388Medicare PIN
OH2645034Medicaid