| Omni Medical Center | |
|
2746 Virginia Ave Louisville KY 40211-3417 | |
| (502) 776-1177 | |
| (502) 772-1761 |
| Full Name | Omni Medical Center |
|---|---|
| Speciality | Internal Medicine |
| Location | 2746 Virginia Ave, Louisville, Kentucky |
| Authorized Official Name and Position | Eugene Giles (SOLO MEMBER OWNER) |
| Authorized Official Contact | 5027761177 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Omni Medical Center 2746 Virginia Ave Louisville KY 40211-3417 Ph: (502) 776-1177 | Omni Medical Center 2746 Virginia Ave Louisville KY 40211-3417 Ph: (502) 776-1177 |
| NPI Number | 1629153705 |
|---|---|
| Provider Enumeration Date | 10/26/2006 |
| Last Update Date | 02/24/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629153705 | NPI | - | NPPES |
| 0400136 | Other | UNITED HEALTHCARE | |
| 1049423 | Other | KY | PASSPORT |
| 64226574 | Medicaid | KY | |
| 000000062872 | Other | KY | ANTHEM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 22657 (Kentucky) | Secondary |
| 207R00000X | Internal Medicine | 22657 (Kentucky) | Primary |
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