MEDICARE: HYPERBARIC MEDICINE GROUP, INC

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	261QM1300X	Multi-Specialty Clinic/Center	2192291L	VI

General Provider Information

NPI Number	:	1316295157
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HYPERBARIC MEDICINE GROUP, INC

Provider Business Mailing Address
First Line	:	4100 SION FARM COMMERCIAL CENTER
Second Line	:
City	:	CHRISTIANSTED
State	:	VI
Zip	:	00820-4433
Country	:	US
Telephone Number	:	340-713-8400
Fax Number	:	340-713-7280

Provider Business Practice Location Address
First Line	:	4100 SION FARM COMMERCIAL CENTER
Second Line	:	SUITE 8
City	:	CHRISTIANSTED
State	:	VI
Zip	:	00820-4433
Country	:	US
Telephone Number	:	340-713-8400
Fax Number	:	340-713-7280

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. IAN KEITH COOK
Credential	:	D.P.M.
Telephone Number	:	340-713-8400

Provider Enumeration Date	:	08/28/2012
Last Update Date	:	08/28/2012

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