Healthcare Provider Details

I. General information

NPI: 1265578819
Provider Name (Legal Business Name): HYEROX 1LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 08/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 BATH RD
BRISTOL PA
19007-3101
US

IV. Provider business mailing address

424 MILL ST CANALS END
BRISTOL PA
19007-4813
US

V. Phone/Fax

Practice location:
  • Phone: 215-785-9798
  • Fax: 215-785-9790
Mailing address:
  • Phone: 215-826-8050
  • Fax: 215-826-8053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number05008318L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number05010460L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License NumberOS008318L
License Number StatePA

VIII. Authorized Official

Name: MS. ROBIN R CAMPBELL
Title or Position: PRACTICE MANAGER
Credential:
Phone: 215-826-8022