Provider Demographics
NPI:1053631341
Name:MARYLAND IOM, LLC
Entity Type:Organization
Organization Name:MARYLAND IOM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOLLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-396-3161
Mailing Address - Street 1:PO BOX 682913
Mailing Address - Street 2:SUITE 306
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-2913
Mailing Address - Country:US
Mailing Address - Phone:877-396-3161
Mailing Address - Fax:615-457-1447
Practice Address - Street 1:700 12TH AVE S
Practice Address - Street 2:SUITE 306
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-3367
Practice Address - Country:US
Practice Address - Phone:877-396-3161
Practice Address - Fax:615-457-1447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-09
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty