Provider Demographics
NPI:1851991079
Name:OMNI MEDICAL CENTER PLLC
Entity Type:Organization
Organization Name:OMNI MEDICAL CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:NESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:763-559-4500
Mailing Address - Street 1:935 WAYZATA BLVD E STE 200
Mailing Address - Street 2:
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-2513
Mailing Address - Country:US
Mailing Address - Phone:763-559-4500
Mailing Address - Fax:763-559-1733
Practice Address - Street 1:935 WAYZATA BLVD E STE 200
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-2513
Practice Address - Country:US
Practice Address - Phone:763-559-4500
Practice Address - Fax:763-559-1733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Multi-Specialty
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty