MBC-Iom, LLC.

Primary specialty

EEG TechnicianTaxonomy code 2472E0500X

Legal business name

MBC-IOM, LLC.

Practice address

627 Ridgemont Dr
Allen, TX 75002-6100

Phone

(972) 632-6877

Fax

(972) 364-1249

NPI assigned

May 15, 2015

Organization subpart

No

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

Authorized official

Name

Ms. Tonya M Gilliam

Title

Owner

Phone

(972) 632-6877

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1431648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431648000000",
    "number": "1275911737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "627 RIDGEMONT DR",
            "city": "ALLEN",
            "state": "TX",
            "postal_code": "750026100",
            "telephone_number": "972-632-6877",
            "fax_number": "972-364-1249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "627 RIDGEMONT DR",
            "city": "ALLEN",
            "state": "TX",
            "postal_code": "750026100",
            "telephone_number": "972-632-6877",
            "fax_number": "972-364-1249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MBC-IOM, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-15",
        "last_updated": "2015-05-15",
        "status": "A",
        "authorized_official_last_name": "GILLIAM",
        "authorized_official_first_name": "TONYA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "972-632-6877",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "2472E0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician, Other, EEG",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 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.