Provider Demographics
NPI:1245429455
Name:NORTHWEST IOM SPECIALISTS
Entity Type:Organization
Organization Name:NORTHWEST IOM SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MCCREA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-329-3301
Mailing Address - Street 1:1900 CHURCH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2234
Mailing Address - Country:US
Mailing Address - Phone:615-329-3301
Mailing Address - Fax:615-329-3302
Practice Address - Street 1:1900 CHURCH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2234
Practice Address - Country:US
Practice Address - Phone:615-329-3301
Practice Address - Fax:615-329-3302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR694976246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty