Healthcare Provider Details

I. General information

NPI: 1730366196
Provider Name (Legal Business Name): NORTH TOWER, LLC IOM SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 05/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 CENTERVIEW DRIVE SUITE 100
BRENTWOOD TN
37027-5274
US

IV. Provider business mailing address

214 CENTERVIEW DRIVE SUITE 100
BRENTWOOD TN
37027-5274
US

V. Phone/Fax

Practice location:
  • Phone: 615-329-3301
  • Fax: 615-329-3302
Mailing address:
  • Phone: 615-329-3301
  • Fax: 615-329-3302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number145973
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES C VANDERVEER
Title or Position: SENIOR VICE PRESIDENT, OPERATIONS F
Credential:
Phone: 615-329-3301