Healthcare Provider Details

I. General information

NPI: 1952673436
Provider Name (Legal Business Name): OMEGA URGENT CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2012
Last Update Date: 01/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 OMEGA DR BUILDING K
NEWARK DE
19713-2057
US

IV. Provider business mailing address

15 OMEGA DR BUILDING 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 TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. DEIRDRE T O'CONNELL
Title or Position: CEO/ADMINISTRATOR
Credential:
Phone: 302-368-9625