1225057458 NPI number — OASIS SPINAL CARE INC.

Table of content: (NPI 1225057458)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225057458 NPI number — OASIS SPINAL CARE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OASIS SPINAL CARE INC.
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:
OASIS CHIROPRACTIC & WELLNESS CENTER
Provider Other Organization Name Type Code:
5
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:
1225057458
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1364
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROANOKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24007-1364
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-966-1423
Provider Business Mailing Address Fax Number:
540-966-4125

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41 SUMMERS WAY
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
ROANOKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24019-8291
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-966-1423
Provider Business Practice Location Address Fax Number:
540-966-4125
Provider Enumeration Date:
07/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BAADER
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
REESE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
540-966-1423

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  0104001266 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: 0104001231 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: 0104556233 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 281806 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 4579046 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7046529 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 281817 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 5115029 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 185516 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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