MEDICARE: VAYU ADVANCED WOUND CLINIC AND HYPERBARICS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261Q00000X	Clinic/Center
2	261QP2300X	Primary Care Clinic/Center
3	261QM2500X	Medical Specialty Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1417013368	OTHER	TX	NPI

General Provider Information

NPI Number	:	1588266605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VAYU ADVANCED WOUND CLINIC AND HYPERBARICS PLLC

Provider Business Mailing Address
First Line	:	13423 BLANCO RD # 767
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-2187
Country	:	US
Telephone Number	:	210-651-1112
Fax Number	:	855-479-2049

Provider Business Practice Location Address
First Line	:	8666 HUEBNER RD STE 220
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1837
Country	:	US
Telephone Number	:	210-651-1112
Fax Number	:	855-479-2049

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. MANJULATHA BADAM
Credential	:	MD, CWSP, UHM
Telephone Number	:	210-651-1112

Provider Enumeration Date	:	11/13/2020
Last Update Date	:	10/19/2021

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