Provider Demographics
NPI:1861866915
Name:ALLIANCE IOM, LLC
Entity Type:Organization
Organization Name:ALLIANCE IOM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:C
Authorized Official - Last Name:NEFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-485-5100
Mailing Address - Street 1:PO BOX 206132
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-6301
Mailing Address - Country:US
Mailing Address - Phone:972-869-0971
Mailing Address - Fax:
Practice Address - Street 1:1801 ROYAL LN
Practice Address - Street 2:908
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75229-3179
Practice Address - Country:US
Practice Address - Phone:972-869-0971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-30
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Single Specialty