Provider Demographics
NPI:1740401660
Name:SURGERY & HYPERBARIC MEDICINE, INC
Entity type:Organization
Organization Name:SURGERY & HYPERBARIC MEDICINE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLARD
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:MANN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:985-785-2218
Mailing Address - Street 1:PO BOX 1764
Mailing Address - Street 2:1057 PAUL MAILLARD ROAD SUITE 250
Mailing Address - City:LULING
Mailing Address - State:LA
Mailing Address - Zip Code:70070-1764
Mailing Address - Country:US
Mailing Address - Phone:985-785-2218
Mailing Address - Fax:985-785-7753
Practice Address - Street 1:1057 PAUL MAILLARD RD
Practice Address - Street 2:SUITE 250
Practice Address - City:LULING
Practice Address - State:LA
Practice Address - Zip Code:70070-4349
Practice Address - Country:US
Practice Address - Phone:985-785-2218
Practice Address - Fax:985-785-7753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty