Healthcare Provider Details

I. General information

NPI: 1316648777
Provider Name (Legal Business Name): OMUC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 E CALVADA BLVD
PAHRUMP NV
89048-5807
US

IV. Provider business mailing address

5010 S DECATUR BLVD STE H
LAS VEGAS NV
89118-4935
US

V. Phone/Fax

Practice location:
  • Phone: 702-302-4569
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. MICHELE WARD
Title or Position: BILLING MANAGER
Credential:
Phone: 702-302-4569