Healthcare Provider Details

I. General information

NPI: 1548488679
Provider Name (Legal Business Name): OMEGA MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 12/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 OMEGA DR BLDG K
NEWARK DE
19713-2057
US

IV. Provider business mailing address

15 OMEGA DR BLDG K
NEWARK DE
19713-2057
US

V. Phone/Fax

Practice location:
  • Phone: 302-368-5100
  • Fax: 302-266-6369
Mailing address:
  • Phone: 302-368-5100
  • Fax: 302-266-6369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number1998209493
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number1998209493
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number1998209493
License Number StateDE
# 4
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number1998209493
License Number StateDE
# 5
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number1998209493
License Number StateDE

VIII. Authorized Official

Name: MRS. DEIRDRE O'CONNELL
Title or Position: C.E.O.
Credential:
Phone: 302-368-5100