Basic Information
| Provider Information | |||||||||
| NPI: | 1437125416 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OMNI COMMUNITY HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 S. PERIMETER PARK DRIVE | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372114128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157263603 | ||||||||
| FaxNumber: | 6158270421 | ||||||||
| Practice Location | |||||||||
| Address1: | 145 THOMPSON LANE | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372112411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157810013 | ||||||||
| FaxNumber: | 6157810688 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2006 | ||||||||
| LastUpdateDate: | 09/02/2020 | ||||||||
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| AuthorizedOfficialLastName: | JUST | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6157263603 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | L 214-026-3229 | TN | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 2084P0800X | L 214-026-3229 | TN | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 251B00000X | L 214-026-3229 | TN | N | Agencies | Case Management | 363L00000X | L 214-026-3229 | TN | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 103T00000X | L 214-026-3229 | TN | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | 106H00000X | L 214-026-3229 | TN | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 163WC1500X | L 214-026-3229 | TN | N | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | Community Health | 163WP0808X | L 214-026-3229 | TN | N | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 164W00000X | L 214-026-3229 | TN | N | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Providers | Licensed Practical Nurse | 104100000X | L 214-026-3229 | TN | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | 3376955 | 05 | TN | MEDICAID |