Provider Demographics
NPI:1477174027
Name:OMNIS MEDICAL GROUP
Entity Type:Organization
Organization Name:OMNIS MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:BONZA
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:614-813-0764
Mailing Address - Street 1:1985 HENDERSON RD STE 1317
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2401
Mailing Address - Country:US
Mailing Address - Phone:614-881-1828
Mailing Address - Fax:614-881-1792
Practice Address - Street 1:401 NORTH EWING STREET
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130
Practice Address - Country:US
Practice Address - Phone:614-881-1828
Practice Address - Fax:614-881-1792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty