Provider Demographics
NPI:1982203618
Name:NIRVANA HYPERBARIC INSTITUTE LLC
Entity Type:Organization
Organization Name:NIRVANA HYPERBARIC INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:L
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-642-0533
Mailing Address - Street 1:146 MEDICAL PARK ROAD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117
Mailing Address - Country:US
Mailing Address - Phone:704-471-4100
Mailing Address - Fax:704-471-4101
Practice Address - Street 1:146 MEDICAL PARK ROAD
Practice Address - Street 2:SUITE 110
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117
Practice Address - Country:US
Practice Address - Phone:704-471-4100
Practice Address - Fax:704-471-4101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-23
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Single Specialty