Provider Demographics
NPI:1912377375
Name:TEXAS IOM LLC
Entity type:Organization
Organization Name:TEXAS IOM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:E
Authorized Official - Last Name:PULLIAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-992-3322
Mailing Address - Street 1:23102 FRESCA STREET
Mailing Address - Street 2:RR4 BOX 185X98
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77554
Mailing Address - Country:US
Mailing Address - Phone:713-992-3322
Mailing Address - Fax:281-969-8709
Practice Address - Street 1:23102 FRESCA ST
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77554-1153
Practice Address - Country:US
Practice Address - Phone:713-992-3322
Practice Address - Fax:281-969-8709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty