Provider Demographics
NPI:1396498309
Name:OMNI CLEARWATER, LLC
Entity type:Organization
Organization Name:OMNI CLEARWATER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SIDHARTH
Authorized Official - Middle Name:
Authorized Official - Last Name:PANCHAMIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-202-9026
Mailing Address - Street 1:3140 S FALKENBURG RD STE 205
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-2594
Mailing Address - Country:US
Mailing Address - Phone:813-565-8978
Mailing Address - Fax:813-533-5511
Practice Address - Street 1:1811 N BELCHER RD STE H2
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1433
Practice Address - Country:US
Practice Address - Phone:727-724-6373
Practice Address - Fax:727-724-6377
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OMNI CONCEPTS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-31
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty