Provider Demographics
NPI:1891786620
Name:OMNI HEALTH CORP
Entity Type:Organization
Organization Name:OMNI HEALTH CORP
Other - Org Name:MCP MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROB
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-642-7365
Mailing Address - Street 1:234 TYSON AVE
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-4575
Mailing Address - Country:US
Mailing Address - Phone:731-642-7365
Mailing Address - Fax:731-642-7427
Practice Address - Street 1:234 TYSON AVE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-4575
Practice Address - Country:US
Practice Address - Phone:731-642-7365
Practice Address - Fax:731-642-7427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2013-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000536332B00000X
TN1062333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3546501Medicaid
0471180001Medicare NSC