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General NPI Number Information
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NPI Number | 1447424825
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Entity Type | Organization
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Legal Business Name | OMNIPHASIC INSTITUTE
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Dates
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Enumeration Date | 04/17/2008
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Last Update Date | 04/17/2008
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Provider Practice Location Address
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Address Line | 1354 BASSE RD SUITE 5
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City | SAN ANTONIO
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State | TX
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Zip | 78212-1000
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Country | US
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Telephone | 210-822-6992
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Fax | 210-822-6997
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Provider Business Mailing Address
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Address Line | 1354 BASSE RD SUITE 5
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City | SAN ANTONIO
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State | TX
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Zip | 78212-1000
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Country | US
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Telephone | 210-822-6992
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Fax | 210-822-6997
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. LYNDA ROSE TUSSAY
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Credential |
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Telephone | 210-822-6992
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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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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