Provider Demographics
NPI:1720037062
Name:OMNI CENTER, INC.
Entity Type:Organization
Organization Name:OMNI CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:P.T./DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCONKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-684-3024
Mailing Address - Street 1:920 COLLOREDO BLVD
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-2779
Mailing Address - Country:US
Mailing Address - Phone:931-684-3024
Mailing Address - Fax:931-684-3066
Practice Address - Street 1:920 COLLOREDO BLVD
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-2779
Practice Address - Country:US
Practice Address - Phone:931-684-3024
Practice Address - Fax:931-684-3066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0446552Medicaid
TN0446552Medicaid