1780989970 NPI number — OMEGA DME, LLC

Table of content: (NPI 1780989970)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780989970 NPI number — OMEGA DME, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OMEGA DME, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780989970
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18533 ROSCOE BLVD
Provider Second Line Business Mailing Address:
#159
Provider Business Mailing Address City Name:
NORTHRIDGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91324-4632
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-748-9600
Provider Business Mailing Address Fax Number:
818-746-9601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21977 MIKHAIL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA CLARITA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91390-5720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-748-9600
Provider Business Practice Location Address Fax Number:
818-746-9601
Provider Enumeration Date:
01/19/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SIMS
Authorized Official First Name:
JEFF
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OPERATIONS MANAGER
Authorized Official Telephone Number:
818-745-5583

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 21680 . This is a "CALIFORNIA FOOD & DRUG HOME MEDICAL DEVICE RETAIL LICENSE EXEMPTEE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 54684 . This is a "CALIFORNIA FOOD & DRUG HOME MEDICAL DEVICE RETAIL LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".