Advanced Iom Specialists, LLC

Key facts

NPI

1043728801

Entity type

Organization (NPI type 2)

Primary specialty

Neurology Physician 2084N0400X

Legal business name

ADVANCED IOM SPECIALISTS, LLC

Practice address

2535 W Plata Ave
Mesa, AZ 85202-7860

Phone

(775) 318-3995

NPI assigned

Jan 15, 2018

Organization subpart

No

Authorized official

Name

Elise Kilmer

Title

Manager

Phone

(775) 318-3995

National Provider Directory

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 15, 2018.

{
    "created_epoch": "1515974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1515974400000",
    "number": "1043728801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2535 W PLATA AVE",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852027860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2535 W PLATA AVE",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852027860",
            "telephone_number": "775-318-3995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED IOM SPECIALISTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-15",
        "last_updated": "2018-01-15",
        "status": "A",
        "authorized_official_last_name": "KILMER",
        "authorized_official_first_name": "ELISE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "775-318-3995"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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