Provider Demographics
NPI:1922494459
Name:INTEGRATIVE HYPERBARIC & WOUND CARE LLC
Entity Type:Organization
Organization Name:INTEGRATIVE HYPERBARIC & WOUND CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CALISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-938-1421
Mailing Address - Street 1:410 PINE ST SE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4861
Mailing Address - Country:US
Mailing Address - Phone:703-938-1421
Mailing Address - Fax:703-938-1424
Practice Address - Street 1:410 PINE ST SE
Practice Address - Street 2:SUITE 330
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4861
Practice Address - Country:US
Practice Address - Phone:703-938-1421
Practice Address - Fax:703-938-1424
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIRGINIA FUNCTIONAL MEDICINE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-10
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty