Provider Demographics
NPI:1801494588
Name:OMNI SOUTH HEALTHCARE LLC
Entity type:Organization
Organization Name:OMNI SOUTH HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:225-281-4485
Mailing Address - Street 1:7515 JEFFERSON HWY # 155
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-8308
Mailing Address - Country:US
Mailing Address - Phone:225-921-5697
Mailing Address - Fax:
Practice Address - Street 1:8225 YMCA PLAZA DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-0922
Practice Address - Country:US
Practice Address - Phone:225-921-5697
Practice Address - Fax:913-222-1693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-14
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Multi-Specialty