Provider Demographics
NPI:1821050923
Name:OMI OF JACKSONVILLE INC
Entity Type:Organization
Organization Name:OMI OF JACKSONVILLE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BABITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-888-6411
Mailing Address - Street 1:2200 N COMMERCE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326
Mailing Address - Country:US
Mailing Address - Phone:954-888-6411
Mailing Address - Fax:954-888-6416
Practice Address - Street 1:3716 UNIVERSITY BLVD SOUTH
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216
Practice Address - Country:US
Practice Address - Phone:904-730-7979
Practice Address - Fax:904-730-8181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE1786CMedicare ID - Type Unspecified