MEDICARE: OCCIPITAL IOM, PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	204R00000X	Electrodiagnostic Medicine Physician
2	2084N0400X	Neurology Physician
3	246ZE0600X	Electroneurodiagnostic Specialist/Technologist
4	2084N0600X	Clinical Neurophysiology Physician

General Provider Information

NPI Number	:	1821532300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCCIPITAL IOM, PLLC

Provider Business Mailing Address
First Line	:	6080 S HULEN ST STE 360
Second Line	:	#177
City	:	FT WORTH
State	:	TX
Zip	:	76132-4810
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6080 S HULEN ST STE 360
Second Line	:	#177
City	:	FT WORTH
State	:	TX
Zip	:	76132-4810
Country	:	US
Telephone Number	:	469-420-5214
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SAEID ARYAN
Credential	:	M.D.
Telephone Number	:	469-420-5214

Provider Enumeration Date	:	12/19/2016
Last Update Date	:	12/19/2016

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