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General NPI Number Information
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NPI Number | 1922125764
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Entity Type | Organization
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Legal Business Name | OMEGA HEALTH SERVICES
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 5985 W STATE ST
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City | BOISE
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State | ID
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Zip | 83703-3039
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Country | US
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Telephone | 208-853-0071
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Fax | 208-853-9422
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Provider Business Mailing Address
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Address Line | 5985 W STATE ST
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City | BOISE
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State | ID
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Zip | 83703-3039
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Country | US
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Telephone | 208-853-0071
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Fax | 208-853-9422
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Authorized Official
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Title or Position | MD
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Name | PATRICK J DWYER
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Credential | MD
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Telephone | 208-853-0071
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | M9186
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NP424A
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NP722A
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License Number State | ID
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