Colinasverse Iom LLC

Primary specialty

Surgical TechnologistTaxonomy code 246ZS0410X

Legal business name

COLINASVERSE IOM LLC

Practice address

500 Throckmorton Street Unit 3012
Fort Worth, TX 76102

Phone

(817) 908-8124

Fax

(817) 885-7339

NPI assigned

Sep 11, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Augusto Cezar Lastimosa, 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": "1441929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1441929600000",
    "number": "1114395860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 THROCKMORTON STREET UNIT 3012",
            "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 UNIT 3012",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "76102",
            "telephone_number": "817-908-8124",
            "fax_number": "817-885-7339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLINASVERSE IOM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-11",
        "last_updated": "2015-09-11",
        "status": "A",
        "authorized_official_last_name": "LASTIMOSA",
        "authorized_official_first_name": "AUGUSTO",
        "authorized_official_middle_name": "CEZAR",
        "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": []
}

• Mario Coleman
• Mia Coleman
• Miesha Coleman
• William G Coleman, MD
• Samuel Coleridge
• Taylor Collazo
• Collective Services, Inc
• Collegiate Behavioral Health Associates
• Lori L. Colletti, M.S.,CCC-SLP
• Colleyverse Iom, LLC

• 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 Sep 11, 2015; 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.