Provider Demographics
NPI:1922697861
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:323-590-9128
Mailing Address - Street 1:12566 VALLEY VIEW
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845
Mailing Address - Country:US
Mailing Address - Phone:323-590-9128
Mailing Address - Fax:
Practice Address - Street 1:12566 VALLEY VIEW ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845-1234
Practice Address - Country:US
Practice Address - Phone:704-617-8535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OMNIBUS MEDICAL CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-14
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty