Provider Demographics
NPI:1700621661
Name:HIGH DESERT WOUND CARE AND HYPERBARICS PLLC
Entity type:Organization
Organization Name:HIGH DESERT WOUND CARE AND HYPERBARICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMI
Authorized Official - Middle Name:
Authorized Official - Last Name:YANTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-649-8347
Mailing Address - Street 1:PO BOX 45060
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83711-5060
Mailing Address - Country:US
Mailing Address - Phone:208-649-8347
Mailing Address - Fax:
Practice Address - Street 1:1906 FAIRVIEW AVE STE 130
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-5433
Practice Address - Country:US
Practice Address - Phone:208-649-8347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-01
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion TherapyGroup - Multi-Specialty