NPIMap

Organization Active NPI

Omni Healthcare, Inc.

  • Clinical Medical Laboratory
  • Melbourne, FL
National Provider Identifier
1598736985
Registry record updated Apr 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
800027101 Issued in FL
Legal business name
OMNI HEALTHCARE, INC.
Practice address
95 Bulldog Blvd
Ste 202
Melbourne, FL 32901-3332
Phone
(321) 722-1766
Fax
(321) 722-0346
NPI assigned
Feb 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Craig K Deligdish, M.D.
Title
Medical Director
Phone
(321) 722-1766

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 800027101 FL Primary

Addresses

Primary practice location

95 Bulldog Blvd
Ste 202
Melbourne, FL 32901-3332

Mailing address

95 Bulldog Blvd
Ste 202
Melbourne, FL 32901-3332
Phone (321) 727-2990

Other identifiers 1

IdentifierTypeStateIssuer
374370500-17MedicaidFL

Other names 1

  • Melbourne Medical Lab Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Victor Alvarez MD3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492041600000",
    "number": "1598736985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "95 BULLDOG BLVD",
            "address_2": "STE 202",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329013332",
            "telephone_number": "321-727-2990",
            "fax_number": "321-724-0455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "95 BULLDOG BLVD",
            "address_2": "STE 202",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329013332",
            "telephone_number": "321-722-1766",
            "fax_number": "321-722-0346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OMNI HEALTHCARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-01",
        "last_updated": "2017-04-13",
        "status": "A",
        "authorized_official_last_name": "DELIGDISH",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "321-722-1766",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "FL",
            "license": "800027101",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "374370500-17",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Melbourne Medical Lab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Melbourne, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.