Provider Demographics
NPI:1083300289
Name:OMT HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:OMT HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ORESTES
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDEROS TRUJILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-553-0177
Mailing Address - Street 1:777 N ORANGE AVE APT 515
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-1184
Mailing Address - Country:US
Mailing Address - Phone:786-553-0177
Mailing Address - Fax:
Practice Address - Street 1:777 N ORANGE AVE APT 515
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-1184
Practice Address - Country:US
Practice Address - Phone:786-553-0177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty