1134191323 NPI number — OMNI HEALTHCARE, INC.

Table of content: (NPI 1134191323)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134191323 NPI number — OMNI HEALTHCARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OMNI HEALTHCARE, INC.
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:
1134191323
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1344 S APOLLO BLVD STE 406
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MELBOURNE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32901-3185
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-727-2990
Provider Business Mailing Address Fax Number:
321-724-0455

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1344 S APOLLO BLVD STE 406
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MELBOURNE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32901-3185
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-727-2990
Provider Business Practice Location Address Fax Number:
321-724-0455
Provider Enumeration Date:
02/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DELIGDISH
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
K
Authorized Official Title or Position:
BOARD MEMBER
Authorized Official Telephone Number:
321-727-3495

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RE0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RR0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2082S0099X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 101824 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X , with the licence number: 800001803 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 250871100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 374370500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 374370505 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 374370515 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 374370513 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 030372100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 374370511 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 374370512 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 374370509 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 39254 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 374370517 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 374370507 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: CC5293 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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