Provider Demographics
NPI:1295495331
Name:INTEGRATIVE HYPERBARIC NOVA LLC
Entity type:Organization
Organization Name:INTEGRATIVE HYPERBARIC NOVA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:YVOUNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRIE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-462-4348
Mailing Address - Street 1:410 PINE ST SE STE 320
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4861
Mailing Address - Country:US
Mailing Address - Phone:703-462-4348
Mailing Address - Fax:703-938-1424
Practice Address - Street 1:19465 DEERFIELD AVE STE 308B
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-1701
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:2021-12-29
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty