MEDICARE: OMNI HEALTHCARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician
2	207RH0003X	Hematology & Oncology Physician
3	207RR0500X	Rheumatology Physician
4	261QM1300X	Multi-Specialty Clinic/Center
5	213E00000X	Podiatrist
6	2085R0202X	Diagnostic Radiology Physician	101824	FL
7	207RE0101X	Endocrinology, Diabetes & Metabolism Physician
8	207R00000X	Internal Medicine Physician
9	207RC0000X	Cardiovascular Disease Physician
10	207Q00000X	Family Medicine Physician
11	207RG0100X	Gastroenterology Physician
12	2082S0099X	Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
13	207RP1001X	Pulmonary Disease Physician
14	291U00000X	Clinical Medical Laboratory	800001803	FL
15	174400000X	Specialist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
13	CC5293	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	39254	OTHER	FL	BLUE CROSS BLUE SHIELD
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134191323
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OMNI HEALTHCARE, INC.

Provider Business Mailing Address
First Line	:	1344 S APOLLO BLVD STE 406
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32901-3185
Country	:	US
Telephone Number	:	321-727-2990
Fax Number	:	321-724-0455

Provider Business Practice Location Address
First Line	:	1344 S APOLLO BLVD STE 406
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32901-3185
Country	:	US
Telephone Number	:	321-727-2990
Fax Number	:	321-724-0455

Authorized Official
Title or Position	:	BOARD MEMBER
Name	:	DR. CRAIG K DELIGDISH
Credential	:	MD
Telephone Number	:	321-727-3495

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	10/02/2025

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Directions to “OMNI HEALTHCARE, INC. ” Practice Location

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