Provider Demographics
| NPI: | 1134191323 |
|---|---|
| Name: | OMNI HEALTHCARE, INC. |
| Entity type: | Organization |
| Organization Name: | OMNI HEALTHCARE, INC. |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | BOARD MEMBER |
| Authorized Official - Prefix: | DR |
| Authorized Official - First Name: | CRAIG |
| Authorized Official - Middle Name: | K |
| Authorized Official - Last Name: | DELIGDISH |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | MD |
| Authorized Official - Phone: | 321-727-3495 |
| Mailing Address - Street 1: | 1344 S APOLLO BLVD STE 406 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | MELBOURNE |
| Mailing Address - State: | FL |
| Mailing Address - Zip Code: | 32901-3185 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 321-727-2990 |
| Mailing Address - Fax: | 321-724-0455 |
| Practice Address - Street 1: | 1344 S APOLLO BLVD STE 406 |
| Practice Address - Street 2: | |
| Practice Address - City: | MELBOURNE |
| Practice Address - State: | FL |
| Practice Address - Zip Code: | 32901-3185 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 321-727-2990 |
| Practice Address - Fax: | 321-724-0455 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-02-02 |
| Last Update Date: | 2024-02-21 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 207RC0000X, 207RE0101X, 207Q00000X, 207R00000X, 207RR0500X, 208000000X, 2082S0099X, 213E00000X, 261QM1300X, 207RG0100X, 207RH0003X, 207RP1001X, 174400000X | ||
| FL | 800001803 | 291U00000X |
| FL | 101824 | 2085R0202X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 174400000X | Other Service Providers | Specialist | Group - Multi-Specialty | |
| No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
| No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 291U00000X | Laboratories | Clinical Medical Laboratory | Group - Multi-Specialty | |
| No | 207RR0500X | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | Group - Multi-Specialty |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 2082S0099X | Allopathic & Osteopathic Physicians | Plastic Surgery | Plastic Surgery Within the Head and Neck | Group - Multi-Specialty |
| No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
| No | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Multi-Specialty | |
| No | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | Group - Multi-Specialty |
| No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
| No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
| No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| FL | 250871100 | Medicaid | |
| FL | 374370500 | Medicaid | |
| FL | 374370505 | Medicaid | |
| FL | 374370515 | Medicaid | |
| FL | 374370513 | Medicaid | |
| FL | 030372100 | Medicaid | |
| FL | 374370511 | Medicaid | |
| FL | 374370512 | Medicaid | |
| FL | 374370509 | Medicaid | |
| FL | 39254 | Other | BLUE CROSS BLUE SHIELD |
| FL | 374370517 | Medicaid | |
| FL | 374370507 | Medicaid | |
| FL | CC5293 | Other | RAILROAD MEDICARE |
| 39254 | Medicare PIN | ||
| 39254B | Medicare PIN | ||
| FL | 374370505 | Medicaid | |
| FL | 374370509 | Medicaid | |
| FL | 030372100 | Medicaid | |
| FL | 374370512 | Medicaid | |
| FL | 39254 | Other | BLUE CROSS BLUE SHIELD |
| FL | CC5293 | Other | RAILROAD MEDICARE |
| FL | 374370500 | Medicaid | |
| FL | 374370513 | Medicaid | |
| FL | 374370511 | Medicaid |
