Provider Demographics
NPI:1093381709
Name:OMNI VIRTUAL HEALTH CARE INC
Entity Type:Organization
Organization Name:OMNI VIRTUAL HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:MR
Authorized Official - First Name:KISHORE
Authorized Official - Middle Name:
Authorized Official - Last Name:RASAMALLU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-379-8553
Mailing Address - Street 1:12895 KEYSTONE CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-1526
Mailing Address - Country:US
Mailing Address - Phone:210-379-8553
Mailing Address - Fax:910-900-1239
Practice Address - Street 1:12895 KEYSTONE CT
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-1526
Practice Address - Country:US
Practice Address - Phone:210-379-8553
Practice Address - Fax:910-900-1239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty