NPIMap

Organization Active NPI

Abilene Iom, LLC

  • Electrodiagnostic Medicine Physician
  • Fort Worth, TX
National Provider Identifier
1851837124
Registry record updated Apr 5, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Electrodiagnostic Medicine PhysicianTaxonomy code 204R00000X
Legal business name
ABILENE IOM, LLC
Practice address
111 Boland St
211
Ft Worth, TX 76107-1263
Phone
(214) 269-3875
Fax
(903) 328-6568
NPI assigned
Jan 11, 2017
Last updated
Apr 5, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2017

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

Authorized official

Name
Gina Sullivan
Title
Billing Manager
Phone
(214) 269-3875

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Electrodiagnostic Medicine Physician 204R00000X NU Primary

Addresses

Primary practice location

111 Boland St
211
Ft Worth, TX 76107-1263

Mailing address

111 Boland St
211
Ft Worth, TX 76107-1263
Phone (214) 269-3875

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1484092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491350400000",
    "number": "1851837124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 BOLAND ST",
            "address_2": "211",
            "city": "FT WORTH",
            "state": "TX",
            "postal_code": "761071263",
            "telephone_number": "214-269-3875",
            "fax_number": "903-328-6568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 BOLAND ST",
            "address_2": "211",
            "city": "FT WORTH",
            "state": "TX",
            "postal_code": "761071263",
            "telephone_number": "214-269-3875",
            "fax_number": "903-328-6568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABILENE IOM, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-11",
        "last_updated": "2017-04-05",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "GINA",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "214-269-3875"
    },
    "taxonomies": [
        {
            "code": "204R00000X",
            "taxonomy_group": "",
            "desc": "Electrodiagnostic Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2017; 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.