Provider Demographics
NPI:1932380086
Name:OMNI HEALTH SERVICES, LTD
Entity Type:Organization
Organization Name:OMNI HEALTH SERVICES, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIBIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-897-7907
Mailing Address - Street 1:PO BOX 74424
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44194-4424
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1200 RALSTON AVE
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-1396
Practice Address - Country:US
Practice Address - Phone:419-783-6955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH612948000OtherDEPARTMENT OF LABOR
OH000000492483OtherANTHEM
OH726416OtherBUCKEYE
OH2800188Medicaid
OH05267OtherPARAMOUNT
OH726416OtherBUCKEYE
OHOM9372491Medicare PIN
OH612948000OtherDEPARTMENT OF LABOR
OH05267OtherPARAMOUNT