Provider Demographics
NPI:1063527158
Name:PRO HEAL HYPERBARICS & WOUND CARE
Entity type:Organization
Organization Name:PRO HEAL HYPERBARICS & WOUND CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:FILUTZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-535-4120
Mailing Address - Street 1:PO BOX 1647
Mailing Address - Street 2:2325 CORONADO
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83403-1647
Mailing Address - Country:US
Mailing Address - Phone:208-535-4120
Mailing Address - Fax:208-535-4125
Practice Address - Street 1:2325 CORONAOD
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404
Practice Address - Country:US
Practice Address - Phone:208-535-4120
Practice Address - Fax:208-535-4125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1368749Medicare ID - Type UnspecifiedPRO HEAL GRP NO