Provider Demographics
NPI:1508130162
Name:OMEGA MEDICAL SUPPLY INC.
Entity Type:Organization
Organization Name:OMEGA MEDICAL SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:STODGHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-538-1141
Mailing Address - Street 1:5611 E ALMEDA CT
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-6406
Mailing Address - Country:US
Mailing Address - Phone:480-538-1141
Mailing Address - Fax:
Practice Address - Street 1:5611 E ALMEDA CT
Practice Address - Street 2:
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-6406
Practice Address - Country:US
Practice Address - Phone:480-538-1141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies