Provider Demographics
NPI:1588623433
Name:OMNIMED LLC
Entity Type:Organization
Organization Name:OMNIMED LLC
Other - Org Name:RIVERVIEW MEDICAL CENTER/OCCUMED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-366-7443
Mailing Address - Street 1:2450 INDIA HOOK RD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-3270
Mailing Address - Country:US
Mailing Address - Phone:803-366-7443
Mailing Address - Fax:803-329-1118
Practice Address - Street 1:2450 INDIA HOOK RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3270
Practice Address - Country:US
Practice Address - Phone:803-366-7443
Practice Address - Fax:803-329-1118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE3289OtherMEDIACID SC - DME
4448680OtherAETNA
NC0120IOtherBLUE CROSS BLUE SHIELD NC
SCGP4453Medicaid
4448680OtherAETNA
SCDE3289OtherMEDIACID SC - DME