MEDICARE: HOUSTON HYPERBARIC OXYGEN CENTER LLC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1548995061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOUSTON HYPERBARIC OXYGEN CENTER LLC

Provider Business Mailing Address
First Line	:	18525 W LAKE HOUSTON PKWY STE 104
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77346-3446
Country	:	US
Telephone Number	:	281-713-6543
Fax Number	:

Provider Business Practice Location Address
First Line	:	18525 W LAKE HOUSTON PKWY STE 104
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77346-3446
Country	:	US
Telephone Number	:	281-713-6543
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	MR. BRAD COPUS
Credential	:
Telephone Number	:	281-713-6543

Provider Enumeration Date	:	07/19/2022
Last Update Date	:	05/09/2023

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