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Contact Information

COLLEYVERSE IOM, LLC
500 THROCKMORTON STREET
UNIT 3309
FORT WORTH, TX76102
 Phone: 817-908-8124
 Fax: 817-885-7339
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type
Indicates primary specialty

NPI Profile & details for COLLEYVERSE IOM LLC · (Female)

NPI Number 1013549278
Status Active
Credentials
Entity Individual
Enumeration date 02/06/2020
Last updated 02/06/2020 - About 6 years ago
Sole proprietor 1 Not specified
Identifiers Not Available
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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