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General NPI Number Information
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NPI Number | 1316320880
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Entity Type | Organization
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Legal Business Name | OMNI COMMUNITY HEALTH
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Dates
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Enumeration Date | 07/02/2015
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Last Update Date | 09/02/2020
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Provider Practice Location Address
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Address Line | 1407 UNION AVE SUITE 815
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City | MEMPHIS
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State | TN
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Zip | 38104-3679
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Country | US
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Telephone | 901-800-4645
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Fax | 901-729-6377
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Provider Business Mailing Address
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Address Line | 301 S PERIMETER PARK DRIVE SUITE 210
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City | NASHVILLE
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State | TN
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Zip | 37211-4128
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Country | US
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Telephone | 615-726-3603
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Fax | 615-827-0421
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MARK JUST
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Credential |
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Telephone | 615-726-3603
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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