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General NPI Number Information
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NPI Number | 1699573337
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Entity Type | Organization
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Legal Business Name | OMNI WELLCARE INCORPORATED
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Dates
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Enumeration Date | 03/07/2025
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 1681 E FLAMINGO RD STE 1
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City | LAS VEGAS
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State | NV
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Zip | 89119-5274
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Country | US
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Telephone | 702-573-3317
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Fax |
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Provider Business Mailing Address
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Address Line | 9142 ASPENDALE RANCH CT
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City | LAS VEGAS
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State | NV
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Zip | 89139-7276
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TRACY GO
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Credential |
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Telephone | 702-782-0376
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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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 | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084B0040X
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Taxonomy Name | Behavioral Neurology & Neuropsychiatry Physician
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License Number |
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License Number State |
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