Provider Demographics
NPI:1386004802
Name:PARAMOUNT IOM, LLC
Entity Type:Organization
Organization Name:PARAMOUNT IOM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:K
Authorized Official - Last Name:WAKEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CNIM
Authorized Official - Phone:970-405-0319
Mailing Address - Street 1:592 TRAILDUST DR
Mailing Address - Street 2:
Mailing Address - City:MILLIKEN
Mailing Address - State:CO
Mailing Address - Zip Code:80543-3030
Mailing Address - Country:US
Mailing Address - Phone:970-405-0319
Mailing Address - Fax:
Practice Address - Street 1:592 TRAILDUST DR
Practice Address - Street 2:
Practice Address - City:MILLIKEN
Practice Address - State:CO
Practice Address - Zip Code:80543-3030
Practice Address - Country:US
Practice Address - Phone:970-405-0319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty