Healthcare Provider Details

I. General information

NPI: 1518210962
Provider Name (Legal Business Name): FAYETTEVILLE HYPERBARICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2012
Last Update Date: 03/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3035 BOONE TRAIL EXT STE A
FAYETTEVILLE NC
28304-3860
US

IV. Provider business mailing address

3035 BOONE TRAIL EXT STE A
FAYETTEVILLE NC
28304-3860
US

V. Phone/Fax

Practice location:
  • Phone: 910-920-1165
  • Fax: 910-425-5178
Mailing address:
  • Phone: 910-920-1165
  • Fax: 910-425-5178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name: MRS. DENISE MERCADO
Title or Position: CEO
Credential:
Phone: 910-920-1165