Provider Demographics
NPI:1336498708
Name:OMNI HEALTH MANAGEMENT GROUP
Entity Type:Organization
Organization Name:OMNI HEALTH MANAGEMENT GROUP
Other - Org Name:OMNI MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:OFODILE
Authorized Official - Middle Name:
Authorized Official - Last Name:NWOSU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-350-8500
Mailing Address - Street 1:8700 CENTRAL AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-4831
Mailing Address - Country:US
Mailing Address - Phone:301-350-8500
Mailing Address - Fax:
Practice Address - Street 1:8700 CENTRAL AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-4831
Practice Address - Country:US
Practice Address - Phone:301-350-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC004521261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care