Provider Demographics
NPI:1841749793
Name:5280 IOM, LLC
Entity Type:Organization
Organization Name:5280 IOM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:DONNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-462-7684
Mailing Address - Street 1:PO BOX 1651
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:TX
Mailing Address - Zip Code:77532-1651
Mailing Address - Country:US
Mailing Address - Phone:281-462-7684
Mailing Address - Fax:888-832-5078
Practice Address - Street 1:1700 BASSETT ST UNIT 1021
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-1921
Practice Address - Country:US
Practice Address - Phone:281-462-7684
Practice Address - Fax:888-832-5078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCNIM1816246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCNIM 2012OtherCERTIFIED NEURO-INTRAOPERATIVE MONITOIRNG
COCNIM 1816OtherCERTIFIED NEURO-INTRAOPERATIVE MONITOIRNG