Colleyverse Iom, LLC

Primary specialty

Surgical TechnologistTaxonomy code 246ZS0410X

Legal business name

COLLEYVERSE IOM, LLC

Practice address

500 Throckmorton Street
Unit 3309
Fort Worth, TX 76102

Phone

(817) 908-8124

Fax

(817) 885-7339

NPI assigned

Feb 6, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Augusto C Lastmosa, M.D.

Title

Managing Member

Phone

(817) 366-4777

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1580947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580947200000",
    "number": "1013549278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 THROCKMORTON STREET",
            "address_2": "UNIT 3309",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "76102",
            "telephone_number": "817-908-8124",
            "fax_number": "817-885-7339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 THROCKMORTON STREET",
            "address_2": "UNIT 3309",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "76102",
            "telephone_number": "817-908-8124",
            "fax_number": "817-885-7339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLEYVERSE IOM, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-06",
        "last_updated": "2020-02-06",
        "certification_date": "2020-02-06",
        "status": "A",
        "authorized_official_last_name": "LASTMOSA",
        "authorized_official_first_name": "AUGUSTO",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "817-366-4777",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "246ZS0410X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist/Technologist, Other, Surgical Technologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Colinasverse Iom LLC
• Taylor Collazo
• Collective Services, Inc
• Collegiate Behavioral Health Associates
• Lori L. Colletti, M.S.,CCC-SLP
• Cristy Collier-Moya, LVN
• Catherine Collier, LCSW
• Harley Collier, PA-C
• Jesse Collier, APRN FNP-C
• Landon Collier, CRNA

• Surgical Technologist in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Surgical Technologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.