Provider Demographics
NPI:1245372903
Name:CENTRAL TEXAS HYPERBARICS AND WOUND
Entity type:Organization
Organization Name:CENTRAL TEXAS HYPERBARICS AND WOUND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAREY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:PHILBRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:325-643-5513
Mailing Address - Street 1:123 SOUTH PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801
Mailing Address - Country:US
Mailing Address - Phone:325-649-3642
Mailing Address - Fax:325-649-3646
Practice Address - Street 1:123 SOUTH PARK DRIVE
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801
Practice Address - Country:US
Practice Address - Phone:325-643-5513
Practice Address - Fax:325-649-3646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6662174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0070PLOtherBCBS GROUP #
TXDG4917OtherRR MEDICARE GROUP #
TX00X927Medicare PIN