Provider Demographics
NPI:1174099147
Name:OMNIVAS NWI
Entity type:Organization
Organization Name:OMNIVAS NWI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAND
Authorized Official - Middle Name:
Authorized Official - Last Name:HOODBHOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-858-7376
Mailing Address - Street 1:8127 MERRILLVILLE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6306
Mailing Address - Country:US
Mailing Address - Phone:260-333-1805
Mailing Address - Fax:702-991-7258
Practice Address - Street 1:8127 MERRILLVILLE RD STE 1
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6306
Practice Address - Country:US
Practice Address - Phone:260-333-1805
Practice Address - Fax:702-991-7258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty