Provider Demographics
NPI:1811900459
Name:OMNI PAIM MANAGEMENT PLUS, LLC
Entity type:Organization
Organization Name:OMNI PAIM MANAGEMENT PLUS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-643-3188
Mailing Address - Street 1:PO BOX 1725
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70063-1725
Mailing Address - Country:US
Mailing Address - Phone:504-469-1960
Mailing Address - Fax:504-469-1979
Practice Address - Street 1:700 GAUSE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2852
Practice Address - Country:US
Practice Address - Phone:985-643-3188
Practice Address - Fax:985-643-3770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA214102081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty