Provider Demographics
NPI:1972075323
Name:IRVINGVERSE IOM LLC
Entity type:Organization
Organization Name:IRVINGVERSE IOM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:RAMON
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:BS, CNIM
Authorized Official - Phone:682-560-9127
Mailing Address - Street 1:803 LITTLE CUB WAY
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039
Mailing Address - Country:US
Mailing Address - Phone:682-560-9127
Mailing Address - Fax:817-494-3249
Practice Address - Street 1:803 LITTLE CUB WAY
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76039
Practice Address - Country:US
Practice Address - Phone:682-560-9127
Practice Address - Fax:817-494-3249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-26
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Single Specialty