=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740021229
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HIGH ALTITUDE HYPERBARIC & WELLNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2024
-----------------------------------------------------
Last Update Date | 06/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1713 SUDDERTH DR
-----------------------------------------------------
City | RUIDOSO
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88345-6114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-315-2367
-----------------------------------------------------
Fax | 575-315-2925
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 103 EL PASO RD
-----------------------------------------------------
City | RUIDOSO
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88345-6033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-973-1514
-----------------------------------------------------
Fax | 575-315-2925
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR OF NAPRAPATHY
-----------------------------------------------------
Name | DR. MICHAEL D WIDENER
-----------------------------------------------------
Credential | DN
-----------------------------------------------------
Telephone | 575-973-1514
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 172P00000X
-----------------------------------------------------
Taxonomy Name | Naprapath
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------