Healthcare Provider Details

I. General information

NPI: 1659696029
Provider Name (Legal Business Name): HYPERBARIC ASSOCIATES SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2010
Last Update Date: 03/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 PINE RIDGE BLVD SUITE 300
WAUSAU WI
54401-4120
US

IV. Provider business mailing address

8001 WOODSIDE LN
WAUSAU WI
54401-8467
US

V. Phone/Fax

Practice location:
  • Phone: 715-847-2121
  • Fax:
Mailing address:
  • Phone: 715-573-0760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW THOMAS CLANCY
Title or Position: PRESIDENT
Credential: MD
Phone: 715-573-0760