Provider Demographics
NPI:1255902516
Name:OMI OF GADSDEN PETCT LLC
Entity type:Organization
Organization Name:OMI OF GADSDEN PETCT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:WOMACK
Authorized Official - Last Name:HOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-679-4455
Mailing Address - Street 1:1026 GOODYEAR AVE STE 50
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35903-1101
Mailing Address - Country:US
Mailing Address - Phone:256-546-7507
Mailing Address - Fax:256-492-8345
Practice Address - Street 1:1026 GOODYEAR AVE STE 50
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1101
Practice Address - Country:US
Practice Address - Phone:256-546-7507
Practice Address - Fax:256-492-8345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-08
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty