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NPI Code Detail

MEDICARE: OMEGA PSYCHIATRIC SOLUTIONS

MEDICARE: OMEGA PSYCHIATRIC SOLUTIONS
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
1101YA0400XAddiction (Substance Use Disorder) Counselor
2251S00000XCommunity/Behavioral Health Agency
32084P0800XPsychiatry Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11902891294OTHERSCNPI
21184810665OTHERNPI
31669404950OTHERSCNPI

General Provider Information

NPI Number : 1154892099
Entity Type Code : Organization
Provider Name (Legal Business Name) : OMEGA PSYCHIATRIC SOLUTIONS
Provider Business Mailing Address
First Line : 1735 SAINT JULIAN PL STE 102
Second Line :
City : COLUMBIA
State : SC
Zip : 29204-2402
Country : US
Telephone Number : 803-497-9611
Fax Number : 803-764-2003
Provider Business Practice Location Address
First Line : 1735 SAINT JULIAN PL STE 102
Second Line :
City : COLUMBIA
State : SC
Zip : 29204-2402
Country : US
Telephone Number : 803-497-9611
Fax Number : 803-353-3622
Authorized Official
Title or Position : CO-OWNER
Name : MRS. KIM J GILMORE
Credential : PMCNS, ANP
Telephone Number : 803-497-9611
Provider Enumeration Date : 12/17/2018
Last Update Date : 07/15/2020

Similar Medicare Providers

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Practice Location Address:
1735 SAINT JULIAN PL STE 102
COLUMBIA, SC
29204-2402
Practice Phone: 803-497-9611
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COLUMBIA, SC
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Practice Location Address:
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COLUMBIA, SC
29204-2402
Practice Phone: 803-708-5081
Practice Fax:
1982051470 — TASHEMA UTSEY
Practice Location Address:
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COLUMBIA, SC
29204-2402
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Practice Fax:
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Practice Location Address:
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COLUMBIA, SC
29204-2402
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Practice Fax:
1003351446 — JOCELYN KELLY
Practice Location Address:
1735 SAINT JULIAN PL , SUITE 102
COLUMBIA, SC
29204-2402
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Directions to “OMEGA PSYCHIATRIC SOLUTIONS ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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