Omega Medical Supply, LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

7134684 Issued in MN

Legal business name

OMEGA MEDICAL SUPPLY, LLC

Practice address

125 West Main St
New Prague, MN 56071

Phone

(507) 252-8413

NPI assigned

Aug 14, 2012

Organization subpart

No

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

Authorized official

Name

Mrs. Aderonke Olanrewaju Mordi

Title

President and Ceo

Phone

(507) 252-8413

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1344902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346112000000",
    "number": "1740537331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 WEST MAIN STREET",
            "city": "NEW PRAGUE",
            "state": "MN",
            "postal_code": "560711535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 WEST MAIN ST",
            "city": "NEW PRAGUE",
            "state": "MN",
            "postal_code": "56071",
            "telephone_number": "507-252-8413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OMEGA MEDICAL SUPPLY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-14",
        "last_updated": "2012-08-28",
        "status": "A",
        "authorized_official_last_name": "MORDI",
        "authorized_official_first_name": "ADERONKE",
        "authorized_official_middle_name": "OLANREWAJU",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "507-252-8413",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MN",
            "license": "7134684",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS INSURANCE",
            "identifier": "331L1OM",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "397118000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in New Prague, MN
• Providers in New Prague, MN by specialty
• Durable Medical Equipment & Medical Supplies in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2012; 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.