Provider Demographics
NPI:1861637944
Name:OMEDICUS, INC. P.A.
Entity Type:Organization
Organization Name:OMEDICUS, INC. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:OH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-564-1176
Mailing Address - Street 1:1329 N UNIVERSITY DR
Mailing Address - Street 2:SUITE E-5
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75961-4232
Mailing Address - Country:US
Mailing Address - Phone:936-564-1176
Mailing Address - Fax:936-564-1227
Practice Address - Street 1:1329 N UNIVERSITY DR
Practice Address - Street 2:SUITE E-5
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4232
Practice Address - Country:US
Practice Address - Phone:936-564-1176
Practice Address - Fax:936-564-1227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9109207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty