Provider Demographics
NPI:1629361944
Name:INFINITY IOM LLC
Entity Type:Organization
Organization Name:INFINITY IOM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MS
Authorized Official - Phone:615-712-9574
Mailing Address - Street 1:209 10TH AVE S
Mailing Address - Street 2:SUITE 411
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-4144
Mailing Address - Country:US
Mailing Address - Phone:615-712-9574
Mailing Address - Fax:615-730-8475
Practice Address - Street 1:209 10TH AVE S
Practice Address - Street 2:SUITE 411
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-4144
Practice Address - Country:US
Practice Address - Phone:615-712-9574
Practice Address - Fax:615-730-8475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty