Provider Demographics
NPI:1659018018
Name:OMNIA CARE PHYSICIAN SERVICES LLC
Entity Type:Organization
Organization Name:OMNIA CARE PHYSICIAN SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOKANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-229-8882
Mailing Address - Street 1:350 FALCON RIDGE PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:NV
Mailing Address - Zip Code:89027-8879
Mailing Address - Country:US
Mailing Address - Phone:702-849-0585
Mailing Address - Fax:702-849-0614
Practice Address - Street 1:350 FALCON RIDGE PKWY STE 101
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89027-8879
Practice Address - Country:US
Practice Address - Phone:702-849-0585
Practice Address - Fax:702-849-0614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-17
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty