Healthcare Provider Details

I. General information

NPI: 1659018018
Provider Name (Legal Business Name): OMNIA CARE PHYSICIAN SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2022
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 FALCON RIDGE PKWY STE 101
MESQUITE NV
89027-8879
US

IV. Provider business mailing address

350 FALCON RIDGE PKWY STE 101
MESQUITE NV
89027-8879
US

V. Phone/Fax

Practice location:
  • Phone: 702-849-0585
  • Fax: 702-849-0614
Mailing address:
  • Phone: 702-849-0585
  • Fax: 702-849-0614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM S HOKANSON
Title or Position: MEMBER
Credential:
Phone: 435-229-8882