| Omni Wellness Group Llc | |
|
1149 Experiment Farm Road Troy OH 45373 | |
| (937) 540-9920 | |
| (937) 202-0213 |
| Full Name | Omni Wellness Group Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 1149 Experiment Farm Road, Troy, Ohio |
| Authorized Official Name and Position | Sheila Petrequin (BILLING MANAGER) |
| Authorized Official Contact | 9374389500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Omni Wellness Group Llc 1149 Experiment Farm Rd Troy OH 45373-1071 Ph: (937) 438-9500 | Omni Wellness Group Llc 1149 Experiment Farm Road Troy OH 45373 Ph: (937) 540-9920 |
| NPI Number | 1861982423 |
|---|---|
| Provider Enumeration Date | 05/18/2018 |
| Last Update Date | 10/30/2023 |
| Medicare PECOS PAC ID | 4082962113 |
|---|---|
| Medicare Enrollment ID | O20180807001983 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861982423 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Primary |
| Provider Name | Edward P Clack |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1659629053 PECOS PAC ID: 7315186277 Enrollment ID: I20141122000327 |
| Provider Name | Leslie Marie Stegall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356875397 PECOS PAC ID: 3971854720 Enrollment ID: I20180918003928 |
| Provider Name | Njideka Jacintha Ejinaka |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962043471 PECOS PAC ID: 2567896962 Enrollment ID: I20191217003207 |
| Provider Name | Cindy M Fleming |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063014330 PECOS PAC ID: 7911304712 Enrollment ID: I20210921002941 |
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