Healthcare Provider Details

I. General information

NPI: 1225958374
Provider Name (Legal Business Name): OMNIA MOHAMED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR
COLUMBIA MO
65212-1000
US

IV. Provider business mailing address

4601 FAUROT DR
COLUMBIA MO
65203-0382
US

V. Phone/Fax

Practice location:
  • Phone: 573-884-2986
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number2026010679
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: