Organization · NPI-2

Abilene Iom, LLC

Electrodiagnostic Medicine · Ft Worth, TX

NPI number1851837124
StatusActive
Last updated in NPPESApr 5, 2017

Details

NPI
1851837124
Entity type
Organization (NPI-2)
Legal business name
Abilene Iom, LLC
Organization subpart
No
Enumeration date
Jan 11, 2017
Last updated
Apr 5, 2017

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
204R00000X Electrodiagnostic Medicine––Yes

Practice location

111 Boland St
211
Ft Worth, TX 76107-1263

Phone 214-269-3875 · Fax 903-328-6568

Mailing address

111 Boland St
211
Ft Worth, TX 76107-1263

Phone 214-269-3875 · Fax 903-328-6568

Authorized official

Gina Sullivan
Billing Manager
2142693875

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