Provider Demographics
NPI:1689642027
Name:HYPERBARIC PHYSICIAN SERVICES LLC
Entity Type:Organization
Organization Name:HYPERBARIC PHYSICIAN SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEBRUHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-290-5309
Mailing Address - Street 1:5 RICHLAND MEDICAL PARK
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-8000
Mailing Address - Country:US
Mailing Address - Phone:800-290-5309
Mailing Address - Fax:803-434-4354
Practice Address - Street 1:11803 JEFFERSON AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2565
Practice Address - Country:US
Practice Address - Phone:757-594-1060
Practice Address - Fax:757-594-1066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06239Medicare ID - Type Unspecified