Provider Demographics
NPI:1437652013
Name:OMNIA MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:OMNIA MEDICAL SUPPLY, LLC
Other - Org Name:OMNIA MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:YOHANNES
Authorized Official - Middle Name:
Authorized Official - Last Name:MESFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-900-3518
Mailing Address - Street 1:1104 LUMINA CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-7105
Mailing Address - Country:US
Mailing Address - Phone:702-499-0762
Mailing Address - Fax:
Practice Address - Street 1:1104 LUMINA CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-7105
Practice Address - Country:US
Practice Address - Phone:702-499-0762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-09
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)