Healthcare Provider Details

I. General information

NPI: 1285999862
Provider Name (Legal Business Name): OMNI HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6930 MARKET ST FL 2
UPPER DARBY PA
19082-2308
US

IV. Provider business mailing address

6930 MARKET ST FL 2
UPPER DARBY PA
19082-2308
US

V. Phone/Fax

Practice location:
  • Phone: 484-466-4844
  • Fax:
Mailing address:
  • Phone: 484-466-4844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number4202
License Number StatePA

VIII. Authorized Official

Name: JAN MONTGOMERY
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 215-997-2000