OrganizationActive
Medical Centre Iom Services, PLLC
NPI 1487156162 · Electrodiagnostic Medicine Physician · Ft Worth, TX
Provider details
- NPI number
- 1487156162
- Entity type
- Organization
- Primary specialty
- Electrodiagnostic Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Gina Sullivan, Billing Manager(214) 269-3875
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
111 Boland St Ste 211
Ft Worth, TX 76107-1265
Phone: (214) 269-3875
Fax: (903) 328-6568
Approximate (ZIP-level) locationGet directions
Mailing address
111 Boland St Ste 211
Ft Worth, TX 76107-1265
Registry dates
- Enumerated
- 2018-03-08
- Last updated
- 2018-03-08
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.