Healthcare Provider Details

I. General information

NPI: 1942780895
Provider Name (Legal Business Name): OMEGA HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2018
Last Update Date: 07/26/2021
Certification Date: 07/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 VIRGINIA AVE STE 14
FORT PIERCE FL
34982-5829
US

IV. Provider business mailing address

800 VIRGINIA AVE SUITE 14
FORT PIERCE FL
34982
US

V. Phone/Fax

Practice location:
  • Phone: 772-460-9811
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberME75634
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME75634
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME75634
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME75634
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberME75634
License Number StateFL

VIII. Authorized Official

Name: DAVID NEMBHARD
Title or Position: PRESIDENT
Credential:
Phone: 772-460-9811