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General NPI Number Information
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NPI Number | 1336630342
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Entity Type | Organization
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Legal Business Name | SBS IOM, LLC
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Dates
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Enumeration Date | 05/24/2018
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Last Update Date | 07/18/2018
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Provider Practice Location Address
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Address Line | 320 E NAPOLEON ST #226
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City | SULPHUR
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State | LA
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Zip | 70663-3318
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Country | US
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Telephone | 504-215-8179
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Fax |
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Provider Business Mailing Address
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Address Line | 320 E NAPOLEON ST #226
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City | SULPHUR
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State | LA
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Zip | 70663-3318
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Country | US
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Telephone | 504-215-8179
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Fax |
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Authorized Official
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Title or Position | MDMS NPI COMPLIANCE OFFICE
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Name | MRS. LIZETTE MORIN
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Credential |
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Telephone | 210-598-2801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204R00000X
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Taxonomy Name | Electrodiagnostic Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 246ZE0600X
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Taxonomy Name | Electroneurodiagnostic Specialist/Technologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number |
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License Number State |
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