MEDICARE: OMB, LLC

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	2085R0202X	Diagnostic Radiology Physician
2	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1598507451
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OMB, LLC

Provider Business Mailing Address
First Line	:	PO BOX 242848
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36124-2848
Country	:	US
Telephone Number	:	205-823-3366
Fax Number	:	205-823-6673

Provider Business Practice Location Address
First Line	:	3425 COLONNADE PKWY STE E
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35243-2356
Country	:	US
Telephone Number	:	205-823-3366
Fax Number	:	205-823-6673

Authorized Official
Title or Position	:	OWNER/AUTHORIZED OFFICIAL
Name	:	NICHOLAS C HUGHES
Credential	:
Telephone Number	:	205-823-3366

Provider Enumeration Date	:	06/11/2024
Last Update Date	:	03/04/2026

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