Provider Demographics
NPI:1558687434
Name:OMG 1PC
Entity Type:Organization
Organization Name:OMG 1PC
Other - Org Name:ROCHESTER MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:MARGOLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-399-4400
Mailing Address - Street 1:29992 NORTHWESTERN HWY STE C
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3292
Mailing Address - Country:US
Mailing Address - Phone:947-221-9684
Mailing Address - Fax:248-399-4840
Practice Address - Street 1:3950 S ROCHESTER RD
Practice Address - Street 2:SUITE 1200
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5160
Practice Address - Country:US
Practice Address - Phone:248-844-6000
Practice Address - Fax:248-844-6159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-16
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4123040004Medicare NSC