Foundation Iom LLC

NPI #1639872088 in Ft Worth, Texas

Provider Information

NPI Number: 1639872088
Entity Type: Organization
Organization Name: Foundation Iom LLC
Primary Specialty: Electrodiagnostic Medicine
Enumeration Date: Mar 24, 2023
Last Updated: Mar 24, 2023

Practice Location

Address: 111 BOLAND ST STE 211
City: Ft Worth
State: Texas
ZIP Code: 76107-1265
Phone: (817) 529-8488

Authorized Official

Name: GINA SULLIVAN
Title: PRACTICE ADMINISTRATOR
Phone: (903) 259-0550

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Electrodiagnostic Medicine	204R00000X	Primary

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