Bravo Iom LLC
Electrodiagnostic Medicine in Ft Worth, TX. Organization (NPI-2).
Details
- NPI
- 1003372285
- Entity type
- Organization (NPI-2)
- Legal business name
- Bravo Iom LLC
- Organization subpart
- No
- Enumeration date
- Feb 13, 2019
- Last updated
- Feb 13, 2019
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 204R00000X | Electrodiagnostic Medicine | – | – | Yes |
Practice location
111 Boland St Ste 211Ft Worth, TX 76107-1265
Phone 817-529-8488 · Fax 903-328-6568
Mailing address
111 Boland St Ste 211Ft Worth, TX 76107-1265
Phone 817-529-8488
Authorized official
Gina Sulllivan
Billing Manager
8175288488
Is something wrong?
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