Provider Demographics
NPI:1174884746
Name:OMNI HOME HEALTH
Entity type:Organization
Organization Name:OMNI HOME HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR BILLING A/R COLLECTIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-712-2248
Mailing Address - Street 1:510 HOSPITAL DRIVE SUITE 101
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:510 HOSPITAL DR STE 101
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-5033
Practice Address - Country:US
Practice Address - Phone:615-712-2248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
010713878OtherTRICARE
FL200375966OtherTRICARE
FL593754764OtherTRICARE
FL200527436OtherTRICARE
FL200832146OtherTRICARE
FL593757320OtherTRICARE
FL010713588OtherTRICARE
FL201657488OtherTRICARE
FL272020510OtherTRICARE
FL510606314OtherTRICARE
FL593757325OtherTRICARE
FL593757320OtherTRICARE