Provider Demographics
NPI:1891422341
Name:OMNIBUS MEDICAL CORP
Entity Type:Organization
Organization Name:OMNIBUS MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CODY
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-617-8535
Mailing Address - Street 1:1810 E SAHARA AVE STE 133
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-3707
Mailing Address - Country:US
Mailing Address - Phone:323-590-9128
Mailing Address - Fax:
Practice Address - Street 1:1810 E SAHARA AVE STE 133
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3707
Practice Address - Country:US
Practice Address - Phone:323-590-9128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OMNIBUS MEDICAL CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty