Provider Demographics
NPI:1962825760
Name:MTV IR PLLC
Entity Type:Organization
Organization Name:MTV IR PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:VAN METER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-458-9800
Mailing Address - Street 1:111 STOW AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-2560
Mailing Address - Country:US
Mailing Address - Phone:330-564-2659
Mailing Address - Fax:330-546-7758
Practice Address - Street 1:9101 N CENTRAL EXPY STE 550
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-5947
Practice Address - Country:US
Practice Address - Phone:469-458-9800
Practice Address - Fax:469-458-9900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-29
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ45832085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty