Provider Demographics
NPI:1326799982
Name:IV BAR MED-SPA LLC
Entity Type:Organization
Organization Name:IV BAR MED-SPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:
Authorized Official - Last Name:COLVIN-JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:513-237-6414
Mailing Address - Street 1:7577 CENTRAL PARKE BLVD STE 213
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-6829
Mailing Address - Country:US
Mailing Address - Phone:513-237-6414
Mailing Address - Fax:513-392-4302
Practice Address - Street 1:7577 CENTRAL PARKE BLVD STE 213
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-6829
Practice Address - Country:US
Practice Address - Phone:513-237-6414
Practice Address - Fax:513-392-4302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-15
Last Update Date:2022-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service