Provider Demographics
NPI:1326366055
Name:MICHIGAN IOM, LLC.
Entity Type:Organization
Organization Name:MICHIGAN 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 681325
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-1325
Mailing Address - Country:US
Mailing Address - Phone:615-928-6075
Mailing Address - Fax:615-457-1447
Practice Address - Street 1:1801 W END AVE
Practice Address - Street 2:SUITE 1610
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2526
Practice Address - Country:US
Practice Address - Phone:615-928-6075
Practice Address - Fax:615-457-1447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-05
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty