Provider Demographics
NPI:1134373970
Name:OMNI COMMUNITY HEALTH
Entity type:Organization
Organization Name:OMNI COMMUNITY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:JUST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-726-3603
Mailing Address - Street 1:301 S PERIMETER PARK DRIVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-4128
Mailing Address - Country:US
Mailing Address - Phone:615-726-3603
Mailing Address - Fax:615-827-0421
Practice Address - Street 1:103 WEAKLEY CREEK ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-2237
Practice Address - Country:US
Practice Address - Phone:931-766-1916
Practice Address - Fax:931-766-4016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3376955OtherGROUP MEDICARE
TNQ019917Medicaid