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General NPI Number Information
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NPI Number | 1396086138
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Entity Type | Organization
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Legal Business Name | OMNIHEALTH MEDICAL GROUP
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Dates
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Enumeration Date | 03/04/2013
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Last Update Date | 03/04/2013
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Provider Practice Location Address
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Address Line | 70 LAKE CONCORD RD NE SUITE 100
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City | CONCORD
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State | NC
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Zip | 28025-3057
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Country | US
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Telephone | 704-784-4445
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Fax | 704-784-4335
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Provider Business Mailing Address
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Address Line | 70 LAKE CONCORD RD NE SUITE 100
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City | CONCORD
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State | NC
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Zip | 28025-3057
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Country | US
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Telephone | 704-784-4445
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Fax | 704-784-4335
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Authorized Official
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Title or Position | PT SUPERVISOR
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Name | LAURA ENGLERT SABATINO
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Credential | PT
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Telephone | 704-784-4445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 8452
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License Number State | NC
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