MEDICARE: OMNI EXPRESS HEALTH SERVICES, LLC

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	251E00000X	Home Health Agency
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1306440250
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OMNI EXPRESS HEALTH SERVICES, LLC

Provider Business Mailing Address
First Line	:	6520 ARSENAL ST RM 223
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63139-2433
Country	:	US
Telephone Number	:	314-925-8721
Fax Number	:

Provider Business Practice Location Address
First Line	:	6520 ARSENAL ST RM 223
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63139-2433
Country	:	US
Telephone Number	:	314-925-8721
Fax Number	:	314-925-8724

Authorized Official
Title or Position	:	OWNER
Name	:	RAMAR BISHOP
Credential	:
Telephone Number	:	618-601-2044

Provider Enumeration Date	:	11/22/2020
Last Update Date	:	05/17/2022

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