Provider Demographics
NPI:1902498298
Name:HYPERBARIC THERAPY CLINIC OF INDIANA, LLC
Entity Type:Organization
Organization Name:HYPERBARIC THERAPY CLINIC OF INDIANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:317-418-4702
Mailing Address - Street 1:605 PIEDMONT DR
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-8826
Mailing Address - Country:US
Mailing Address - Phone:317-418-4702
Mailing Address - Fax:
Practice Address - Street 1:14555 HAZEL DELL PKWY STE 140B
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-7000
Practice Address - Country:US
Practice Address - Phone:317-418-4702
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty