Provider Demographics
NPI:1053488536
Name:OMEGA SLEEP DISORDERS AND DIAGNOSITIC CENTER LLC
Entity type:Organization
Organization Name:OMEGA SLEEP DISORDERS AND DIAGNOSITIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-527-5337
Mailing Address - Street 1:5225 HICKORY PARK DRIVE
Mailing Address - Street 2:STE A
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059
Mailing Address - Country:US
Mailing Address - Phone:804-527-5337
Mailing Address - Fax:804-527-5222
Practice Address - Street 1:5225 HICKORY PARK DR STE A
Practice Address - Street 2:SUITE A
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-2620
Practice Address - Country:US
Practice Address - Phone:804-527-5337
Practice Address - Fax:804-527-5337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA291U00000X, 291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory