Provider Demographics
NPI:1013964675
Name:OMNI HOUSECALLS LLC
Entity Type:Organization
Organization Name:OMNI HOUSECALLS LLC
Other - Org Name:MEDICAL HOUSECALLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-446-0524
Mailing Address - Street 1:2080 N STATE HIGHWAY 360
Mailing Address - Street 2:SUITE 370
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-1493
Mailing Address - Country:US
Mailing Address - Phone:972-206-0347
Mailing Address - Fax:972-206-0365
Practice Address - Street 1:2080 N STATE HIGHWAY 360
Practice Address - Street 2:SUITE 370
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-1493
Practice Address - Country:US
Practice Address - Phone:972-206-0347
Practice Address - Fax:972-206-0365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0043NNOtherBCBS
TX179190701Medicaid
TXDE4339OtherRR MEDICARE
TX179190701Medicaid