Omni Clinic PA
Exclusive Provider Organization in Jacksonville, NC. Organization (NPI-2).
NPI number1790748960
StatusActive
Last updated in NPPESAug 19, 2014
Details
- NPI
- 1790748960
- Entity type
- Organization (NPI-2)
- Legal business name
- Omni Clinic PA
- Organization subpart
- No
- Enumeration date
- Apr 10, 2006
- Last updated
- Aug 19, 2014
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 302F00000X | Exclusive Provider Organization | 9901455 | NC | Yes |
Practice location
22 Office Park DrJacksonville, NC 28546-7325
Phone 910-219-4070 · Fax 910-219-4071
Mailing address
Po Box 12353Jacksonville, NC 28546-2353
Phone 910-219-4070 · Fax 910-219-4071
Authorized official
Teresa Burkett
Office Supervisor
9102194070
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