| Omni Virtual Health Care Inc | |
|
12895 Keystone Ct Alpharetta GA 30009-1526 | |
| (210) 379-8553 | |
| (910) 900-1239 |
| Full Name | Omni Virtual Health Care Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 12895 Keystone Ct, Alpharetta, Georgia |
| Authorized Official Name and Position | Kishore Rasamallu (MD) |
| Authorized Official Contact | 2103798553 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Omni Virtual Health Care Inc 12895 Keystone Ct Alpharetta GA 30009-1526 Ph: (210) 379-8553 | Omni Virtual Health Care Inc 12895 Keystone Ct Alpharetta GA 30009-1526 Ph: (210) 379-8553 |
| NPI Number | 1093381709 |
|---|---|
| Provider Enumeration Date | 06/02/2021 |
| Last Update Date | 06/20/2024 |
| Medicare PECOS PAC ID | 2769883842 |
|---|---|
| Medicare Enrollment ID | O20210628000175 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093381709 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Allison Brooke Santizo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891112033 PECOS PAC ID: 6103137823 Enrollment ID: I20150623000781 |
| Provider Name | Thammi Raju Vegiraju |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1356611958 PECOS PAC ID: 5092956748 Enrollment ID: I20160912000857 |
| Provider Name | Karrie Hodges Pusateri |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750839064 PECOS PAC ID: 0446539860 Enrollment ID: I20161108000093 |
| Provider Name | Kishore Reddy Rasamallu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1568667863 PECOS PAC ID: 1254427388 Enrollment ID: I20190313003055 |
| Provider Name | Nithin Devireddy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083141477 PECOS PAC ID: 2567735061 Enrollment ID: I20220317000606 |
| Provider Name | Mystical Evans |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982338737 PECOS PAC ID: 2062894017 Enrollment ID: I20220808001171 |
| Provider Name | Noelle Ann Bucariza |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518678994 PECOS PAC ID: 5294197828 Enrollment ID: I20230815000970 |
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