MEDICARE: HYPERBARIC GURU, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1083141840
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HYPERBARIC GURU, LLC

Provider Business Mailing Address
First Line	:	6752 W GULF TO LAKE HWY
Second Line	:	SUITE 204
City	:	CRYSTAL RIVER
State	:	FL
Zip	:	34429-9348
Country	:	US
Telephone Number	:	929-374-4268
Fax Number	:	929-214-4268

Provider Business Practice Location Address
First Line	:	6752 W GULF TO LAKE HWY
Second Line	:	SUITE 204
City	:	CRYSTAL RIVER
State	:	FL
Zip	:	34429-9348
Country	:	US
Telephone Number	:	929-374-4268
Fax Number	:	929-214-4268

Authorized Official
Title or Position	:	PRESIDENT/MANAGING MEMBER
Name	:	MR. CHRIS GRANT
Credential	:
Telephone Number	:	352-566-2751

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	05/11/2017

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