Provider Demographics
NPI:1255063004
Name:OMNI AMBULATORY SURGERY CENTER INC.
Entity type:Organization
Organization Name:OMNI AMBULATORY SURGERY CENTER INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:NIKOLOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-247-1932
Mailing Address - Street 1:436 N BEDFORD DR STE 205
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4312
Mailing Address - Country:US
Mailing Address - Phone:310-247-8978
Mailing Address - Fax:310-425-3214
Practice Address - Street 1:436 N BEDFORD DR STE 205
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4312
Practice Address - Country:US
Practice Address - Phone:310-247-8978
Practice Address - Fax:310-425-3214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-29
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical