| Omfs Practice Inc. | |
|
2917 Crossing Ct Ste A Champaign IL 61822-6185 | |
| (217) 366-1246 | |
| Not Available |
| Full Name | Omfs Practice Inc. |
|---|---|
| Speciality | Dentist |
| Location | 2917 Crossing Ct Ste A, Champaign, Illinois |
| Authorized Official Name and Position | Victor H Escobar (PRESIDENT) |
| Authorized Official Contact | 2173661246 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Omfs Practice Inc. 2917 Crossing Ct Ste A Champaign IL 61822-6185 Ph: (217) 366-1246 | Omfs Practice Inc. 2917 Crossing Ct Ste A Champaign IL 61822-6185 Ph: (217) 366-1246 |
| NPI Number | 1265946081 |
|---|---|
| Provider Enumeration Date | 12/01/2017 |
| Last Update Date | 12/01/2017 |
| Medicare PECOS PAC ID | 3173877966 |
|---|---|
| Medicare Enrollment ID | O20181114001265 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265946081 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 021.002026 (Illinois) | Primary |
| Provider Name | Victor Escobar |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1750397501 PECOS PAC ID: 4385726512 Enrollment ID: I20080128000338 |
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