Provider Demographics
NPI:1447424825
Name:OMNIPHASIC INSTITUTE
Entity Type:Organization
Organization Name:OMNIPHASIC INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:TUSSAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-822-6992
Mailing Address - Street 1:1354 BASSE RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-1000
Mailing Address - Country:US
Mailing Address - Phone:210-822-6992
Mailing Address - Fax:210-822-6997
Practice Address - Street 1:1354 BASSE RD
Practice Address - Street 2:SUITE 5
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-1000
Practice Address - Country:US
Practice Address - Phone:210-822-6992
Practice Address - Fax:210-822-6997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management