Provider Demographics
NPI:1548488679
Name:OMEGA MEDICAL CENTER, LLC
Entity type:Organization
Organization Name:OMEGA MEDICAL CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEIRDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:O'CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-368-5100
Mailing Address - Street 1:15 OMEGA DR BLDG K
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2057
Mailing Address - Country:US
Mailing Address - Phone:302-368-5100
Mailing Address - Fax:302-266-6369
Practice Address - Street 1:15 OMEGA DR BLDG K
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2057
Practice Address - Country:US
Practice Address - Phone:302-368-5100
Practice Address - Fax:302-266-6369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1998209493261QP2000X, 261QR0200X, 261QR0400X, 261QX0100X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine