Provider Demographics
NPI:1942171368
Name:OMAHA ENTERPRISE LLC
Entity type:Organization
Organization Name:OMAHA ENTERPRISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAFIZA
Authorized Official - Middle Name:JAVERIA
Authorized Official - Last Name:AMIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-951-4122
Mailing Address - Street 1:3664 CLUB DR STE 101H
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-2959
Mailing Address - Country:US
Mailing Address - Phone:404-951-4122
Mailing Address - Fax:
Practice Address - Street 1:3664 CLUB DR STE 101H
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-2959
Practice Address - Country:US
Practice Address - Phone:404-951-4122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies