MEDICARE: OMNI HEALTHCARE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	101824	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	CC5293	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	39254	OTHER	FL	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053382457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OMNI HEALTHCARE, INC

Provider Business Mailing Address
First Line	:	1344 S APOLLO BLVD STE 406
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32901-3185
Country	:	US
Telephone Number	:	321-727-2990
Fax Number	:	321-724-0455

Provider Business Practice Location Address
First Line	:	1344 S APOLLO BLVD
Second Line	:	STE 102
City	:	MELBOURNE
State	:	FL
Zip	:	32901-3183
Country	:	US
Telephone Number	:	321-777-7888
Fax Number	:	321-773-7738

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	CRAIG K DELIGDISH
Credential	:	MD
Telephone Number	:	321-777-7888

Provider Enumeration Date	:	02/01/2006
Last Update Date	:	10/02/2025

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Directions to “OMNI HEALTHCARE, INC ” Practice Location

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