Provider Demographics
NPI:1992929970
Name:IBIS TVM, INC
Entity type:Organization
Organization Name:IBIS TVM, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:VOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-222-1550
Mailing Address - Street 1:8421 UNIVERSITY BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-1036
Mailing Address - Country:US
Mailing Address - Phone:515-222-1550
Mailing Address - Fax:515-222-1549
Practice Address - Street 1:8421 UNIVERSITY BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-1036
Practice Address - Country:US
Practice Address - Phone:515-222-1550
Practice Address - Fax:515-222-1549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IANONE251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0286823Medicaid