Provider Demographics
NPI:1417168485
Name:OMNI CLINIC
Entity Type:Organization
Organization Name:OMNI CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ADETOKUNBO
Authorized Official - Middle Name:
Authorized Official - Last Name:LADIPO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-236-3031
Mailing Address - Street 1:1306 LEIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-4614
Mailing Address - Country:US
Mailing Address - Phone:256-236-3031
Mailing Address - Fax:
Practice Address - Street 1:1306 LEIGHTON AVE
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-4614
Practice Address - Country:US
Practice Address - Phone:256-236-3031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1417055179OtherABAYOMI SANUSI MD- NPI NU
AL1417168485OtherOMNI CLINIC -GROUP NPI NU
AL1972601607OtherADETOKUNBO LADIPO MD- NPI