Provider Demographics
NPI:1811907538
Name:OMEGA PRACTICE MANAGEMENT INC
Entity type:Organization
Organization Name:OMEGA PRACTICE MANAGEMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL MEDICINE & REHABILITIATION
Authorized Official - Prefix:DR
Authorized Official - First Name:ANIL
Authorized Official - Middle Name:K
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-392-7071
Mailing Address - Street 1:9130 E 77TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4922
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1145 S. UTICA
Practice Address - Street 2:STE 901
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4013
Practice Address - Country:US
Practice Address - Phone:918-392-7071
Practice Address - Fax:918-392-7072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK085841112004OtherBLUECROSSBLUESHIELD OF OK
OK100010230BMedicaid
OK085841112004OtherBLUECROSSBLUESHIELD OF OK
OK800522189Medicare ID - Type Unspecified
OK085841112004OtherBLUECROSSBLUESHIELD OF OK