1750390548 NPI number — OXFORD EYE SURGERY CENTER,L.P

Table of content: (NPI 1750390548)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750390548 NPI number — OXFORD EYE SURGERY CENTER,L.P

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OXFORD EYE SURGERY CENTER,L.P
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RAYNER SURGERY CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750390548
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2604 S LAMAR BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OXFORD
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38655-5243
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-234-6621
Provider Business Mailing Address Fax Number:
662-234-8703

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2604 S LAMAR BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OXFORD
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38655-5243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-234-6621
Provider Business Practice Location Address Fax Number:
662-234-8703
Provider Enumeration Date:
08/08/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TANN
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
662-234-6621

Provider Taxonomy Codes

  • Taxonomy code: 261QS0132X , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00770617 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".