Provider Demographics
NPI:1144779380
Name:5280 IOM PRO, LLC
Entity Type:Organization
Organization Name:5280 IOM PRO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:BISHOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:346-221-1597
Mailing Address - Street 1:PO BOX 1651
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:TX
Mailing Address - Zip Code:77532-1651
Mailing Address - Country:US
Mailing Address - Phone:281-462-7684
Mailing Address - Fax:888-832-5078
Practice Address - Street 1:1700 BASSETT ST UNIT 1021
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-1921
Practice Address - Country:US
Practice Address - Phone:346-221-1597
Practice Address - Fax:832-581-4677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty