Healthcare Provider Details

I. General information

NPI: 1083005375
Provider Name (Legal Business Name): OMS REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2015
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9678 MARION RIDGE DR
KANSAS CITY MO
64137
US

IV. Provider business mailing address

3750 PRIORITY WAY SOUTH DR
INDIANAPOLIS IN
46240-3831
US

V. Phone/Fax

Practice location:
  • Phone: 816-783-5003
  • Fax: 816-783-5004
Mailing address:
  • Phone: 877-813-0205
  • Fax: 877-604-3468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: RICHARD DELEON
Title or Position: COMPLIANCE COORDINATOR
Credential:
Phone: 317-436-6178