Provider Demographics
NPI:1194770495
Name:OMEGA IMAGING, INC.
Entity type:Organization
Organization Name:OMEGA IMAGING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-776-8001
Mailing Address - Street 1:44489 TOWN CENTER WAY
Mailing Address - Street 2:SUITE D BOX 532
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-2789
Mailing Address - Country:US
Mailing Address - Phone:760-776-8001
Mailing Address - Fax:760-836-3934
Practice Address - Street 1:26161 MARGUERITE PARKWAY, SUITE A
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-3162
Practice Address - Country:US
Practice Address - Phone:949-600-5151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA750462471M1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
548350Medicare UPIN
TD096Medicare ID - Type Unspecified