Provider Demographics
NPI:1902809056
Name:OMEGA HEALTH SUPPLY & DELIVERY, INC
Entity Type:Organization
Organization Name:OMEGA HEALTH SUPPLY & DELIVERY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-298-9799
Mailing Address - Street 1:9909 S SHORE DR
Mailing Address - Street 2:SUITE 1F
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-5037
Mailing Address - Country:US
Mailing Address - Phone:651-298-9799
Mailing Address - Fax:866-454-7922
Practice Address - Street 1:9909 S SHORE DR
Practice Address - Street 2:STE 1F
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-5037
Practice Address - Country:US
Practice Address - Phone:651-298-9799
Practice Address - Fax:866-454-7922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5157430001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1704686Medicaid
MN5157430001Medicare ID - Type UnspecifiedNATIONAL