Organization
OMNIMED LLC
Active
Other names
Riverview House Calls, Riverview Medical Center/Occumed
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER RANDEL (OFFICE MANAGER)
(803) 366-7443
Entity
Organization
Contact information
Practice address
2450 INDIA HOOK RD, ROCK HILL, SC 29732-3270
(803) 366-7443
(803) 329-1118
Mailing address
2450 INDIA HOOK RD, ROCK HILL, SC 29732-3270
(803) 366-7443
(803) 329-1118
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0120I
BLUE CROSS BLUE SHIELD NC
NC
01
—
4448680
AETNA
—
01
—
DE3289
MEDIACID SC - DME
SC
05
—
GP4453
—
SC
Enumeration date
03/20/2006
Last updated
03/08/2021
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