Healthcare Provider Details

I. General information

NPI: 1598959538
Provider Name (Legal Business Name): OMS FACILITY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 BILLINGSLEY RD SUITE 105
CHARLOTTE NC
28211-1046
US

IV. Provider business mailing address

411 BILLINGSLEY RD SUITE 105
CHARLOTTE NC
28211-1046
US

V. Phone/Fax

Practice location:
  • Phone: 704-820-2982
  • Fax: 704-820-3185
Mailing address:
  • Phone: 704-820-2982
  • Fax: 704-820-3185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: MR. DANNY KETOLA
Title or Position: BUSINESS ADMINISTRATOR
Credential:
Phone: 704-820-1187