Healthcare Provider Details

I. General information

NPI: 1538082748
Provider Name (Legal Business Name): OMNIA MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9568 KINGS CHARTER DR STE 204
ASHLAND VA
23005-0078
US

IV. Provider business mailing address

9568 KINGS CHARTER DR STE 204
ASHLAND VA
23005-0078
US

V. Phone/Fax

Practice location:
  • Phone: 804-533-5616
  • Fax: 301-560-8244
Mailing address:
  • Phone: 804-533-5616
  • Fax: 301-560-8244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name: ZOE BUTLER
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 804-533-5616