Provider Demographics
NPI:1356848352
Name:OMHC, LLC
Entity Type:Organization
Organization Name:OMHC, LLC
Other - Org Name:OREGON MAN CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELSY
Authorized Official - Middle Name:
Authorized Official - Last Name:CEJA RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-505-8773
Mailing Address - Street 1:PO BOX 70673
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97475-0133
Mailing Address - Country:US
Mailing Address - Phone:541-285-3108
Mailing Address - Fax:541-780-6069
Practice Address - Street 1:595 SW BLUFF DR STE A
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1283
Practice Address - Country:US
Practice Address - Phone:541-508-4858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-07
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center