MEDICARE: OMEGA DIAGNOSTICS, 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	291U00000X	Clinical Medical Laboratory

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598712879
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OMEGA DIAGNOSTICS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 3780
Second Line	:
City	:	TUPELO
State	:	MS
Zip	:	38803-3780
Country	:	US
Telephone Number	:	318-841-9526
Fax Number	:	318-841-9557

Provider Business Practice Location Address
First Line	:	5266 COMMERCE ST BLDG B
Second Line	:
City	:	SAINT FRANCISVILLE
State	:	LA
Zip	:	70775-4409
Country	:	US
Telephone Number	:	225-635-2439
Fax Number	:	225-784-3488

Authorized Official
Title or Position	:	CEO
Name	:	VIVEK K. KHARE
Credential	:	M.D.
Telephone Number	:	318-621-8820

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	08/26/2022

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