Provider Demographics
NPI:1841078946
Name:OLYSIS, LLC
Entity type:Organization
Organization Name:OLYSIS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / ELECTROLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPE
Authorized Official - Phone:214-326-5721
Mailing Address - Street 1:509 E BYRON NELSON BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262-6183
Mailing Address - Country:US
Mailing Address - Phone:682-593-1442
Mailing Address - Fax:
Practice Address - Street 1:509 E BYRON NELSON BLVD STE C
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:TX
Practice Address - Zip Code:76262-6183
Practice Address - Country:US
Practice Address - Phone:682-593-1442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-19
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty