Provider Demographics
NPI:1710159355
Name:OMEGA HEALTH CARE OF SOUTHWEST MISSOURI INC
Entity Type:Organization
Organization Name:OMEGA HEALTH CARE OF SOUTHWEST MISSOURI INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:LEO
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-814-7105
Mailing Address - Street 1:7520 W 160TH ST
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:KS
Mailing Address - Zip Code:66085-8100
Mailing Address - Country:US
Mailing Address - Phone:417-886-6995
Mailing Address - Fax:
Practice Address - Street 1:2041 S STEWART AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2522
Practice Address - Country:US
Practice Address - Phone:417-886-6995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO825857709Medicaid
MO261590Medicare Oscar/Certification