Provider Demographics
NPI:1780989970
Name:OMEGA DME, LLC
Entity type:Organization
Organization Name:OMEGA DME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:L
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-745-5583
Mailing Address - Street 1:18533 ROSCOE BLVD
Mailing Address - Street 2:#159
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-4632
Mailing Address - Country:US
Mailing Address - Phone:818-748-9600
Mailing Address - Fax:818-746-9601
Practice Address - Street 1:21977 MIKHAIL ST
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91390-5720
Practice Address - Country:US
Practice Address - Phone:818-748-9600
Practice Address - Fax:818-746-9601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA21680OtherCALIFORNIA FOOD & DRUG HOME MEDICAL DEVICE RETAIL LICENSE EXEMPTEE
CA54684OtherCALIFORNIA FOOD & DRUG HOME MEDICAL DEVICE RETAIL LICENSE