Provider Demographics
NPI:1053382457
Name:OMNI HEALTHCARE, INC
Entity type:Organization
Organization Name:OMNI HEALTHCARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:K
Authorized Official - Last Name:DELIGDISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-777-7888
Mailing Address - Street 1:1344 S APOLLO BLVD STE 406
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3185
Mailing Address - Country:US
Mailing Address - Phone:321-727-2990
Mailing Address - Fax:321-724-0455
Practice Address - Street 1:1344 S APOLLO BLVD
Practice Address - Street 2:STE 102
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3183
Practice Address - Country:US
Practice Address - Phone:321-777-7888
Practice Address - Fax:321-773-7738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1018242085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL39254OtherBLUE CROSS BLUE SHIELD
FL250871100Medicaid
FLCC5293OtherRAILROAD MEDICARE
FL250871100Medicaid