Provider Demographics
NPI:1205838067
Name:OM HEALTHCARE LLC
Entity Type:Organization
Organization Name:OM HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:DARLENE
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-326-4355
Mailing Address - Street 1:125 E BROAD ST
Mailing Address - Street 2:STE 202
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035
Mailing Address - Country:US
Mailing Address - Phone:440-329-7305
Mailing Address - Fax:440-329-7798
Practice Address - Street 1:125 E BROAD ST
Practice Address - Street 2:STE 215
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035
Practice Address - Country:US
Practice Address - Phone:440-329-7305
Practice Address - Fax:440-329-7798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH09328932OtherMEDICARE STE 215
OH2348963Medicaid
OH09328931Medicare ID - Type UnspecifiedSTE 202