Healthcare Provider Details

I. General information

NPI: 1770696437
Provider Name (Legal Business Name): OMNI HEALTH CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 TYSON AVE
PARIS TN
38242-5853
US

IV. Provider business mailing address

234 TYSON AVE
PARIS TN
38242-5853
US

V. Phone/Fax

Practice location:
  • Phone: 731-642-2451
  • Fax: 731-642-7246
Mailing address:
  • Phone: 731-642-2451
  • Fax: 731-642-7427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1062
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number1062
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1062
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number1062
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number1062
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number1062
License Number StateTN
# 7
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number1062
License Number StateTN
# 8
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number1062
License Number StateTN

VIII. Authorized Official

Name: J NICHOLS
Title or Position: OWNER
Credential:
Phone: 731-642-2451