Organization
OMNI CLINIC PA
Active
Organization
OMNI CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TERESA BURKETT (OFFICE SUPERVISOR)
(910) 219-4070
Entity
Organization
Contact information
Practice address
22 OFFICE PARK DR, JACKSONVILLE, NC 28546-7325
(910) 219-4070
(910) 219-4071
Mailing address
PO BOX 12353, JACKSONVILLE, NC 28546-2353
(910) 219-4070
(910) 219-4071
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
9901455
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5909266
—
NC
Enumeration date
04/10/2006
Last updated
08/19/2014
Update your record
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