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NPI Code Detail

MEDICARE: MICHIGAN IOM, LLC.

MEDICARE: MICHIGAN IOM, LLC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist

General Provider Information

NPI Number : 1326366055
Entity Type Code : Organization
Provider Name (Legal Business Name) : MICHIGAN IOM, LLC.
Provider Business Mailing Address
First Line : PO BOX 681325
Second Line :
City : FRANKLIN
State : TN
Zip : 37068-1325
Country : US
Telephone Number : 615-928-6075
Fax Number : 615-457-1447
Provider Business Practice Location Address
First Line : 1801 W END AVE
Second Line : SUITE 1610
City : NASHVILLE
State : TN
Zip : 37203-2526
Country : US
Telephone Number : 615-928-6075
Fax Number : 615-457-1447
Authorized Official
Title or Position : PRESIDENT & CEO
Name : MR. BRIAN MCCOLLUM
Credential :
Telephone Number : 877-396-3161
Provider Enumeration Date : 05/05/2010
Last Update Date : 02/22/2017

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Directions to “MICHIGAN IOM, LLC. ” Practice Location

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