Provider Demographics
NPI:1215255609
Name:OMEGA CHOICE INC
Entity type:Organization
Organization Name:OMEGA CHOICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RALPHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:435-216-2184
Mailing Address - Street 1:9030 W SAHARA AVE
Mailing Address - Street 2:STE 406
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-5744
Mailing Address - Country:US
Mailing Address - Phone:435-216-2184
Mailing Address - Fax:
Practice Address - Street 1:2250 N CORAL CANYON BLVD
Practice Address - Street 2:STE 102
Practice Address - City:WASHINGTON
Practice Address - State:UT
Practice Address - Zip Code:84780-2649
Practice Address - Country:US
Practice Address - Phone:435-216-2184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT180211-1204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty