Provider Demographics
NPI:1518325877
Name:OMED INC.
Entity Type:Organization
Organization Name:OMED INC.
Other - Org Name:GREAT DAY MASSAGE WORKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:570-476-4317
Mailing Address - Street 1:146 AZALEA DR
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-7706
Mailing Address - Country:US
Mailing Address - Phone:570-476-4317
Mailing Address - Fax:
Practice Address - Street 1:146 AZALEA DR
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-7706
Practice Address - Country:US
Practice Address - Phone:570-476-4317
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG000382332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site