Healthcare Provider Details

I. General information

NPI: 1710145214
Provider Name (Legal Business Name): OMEGA PLANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3324 OZARK DRIVE
EDMOND OK
73034
US

IV. Provider business mailing address

3324 OZARK DRIVE
EDMOND OK
73034
US

V. Phone/Fax

Practice location:
  • Phone: 405-330-3008
  • Fax:
Mailing address:
  • Phone: 405-330-3008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3242
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberR0076201
License Number StateOK

VIII. Authorized Official

Name: LINDA LEE SALESKI
Title or Position: MEMBER MANAGER
Credential: LCSW
Phone: 405-706-4009