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General NPI Number Information
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NPI Number | 1780403964
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Entity Type | Organization
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Legal Business Name | OMEGA INTEGRATIVE CARE
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Dates
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Enumeration Date | 10/07/2024
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 910 OLD CAMP RD STE 112
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City | THE VILLAGES
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State | FL
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Zip | 32162-5605
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Country | US
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Telephone | 352-240-1471
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Fax |
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Provider Business Mailing Address
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Address Line | 11220 HESS WAY
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City | OXFORD
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State | FL
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Zip | 34484-3474
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Country | US
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Telephone | 352-572-9016
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SARAH TATE
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Credential | APRN
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Telephone | 352-572-9016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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