1649775123 NPI number — OXFORD OUTPATIENT CENTER, LLC

Table of content: (NPI 1649775123)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649775123 NPI number — OXFORD OUTPATIENT CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OXFORD OUTPATIENT CENTER, LLC
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:
Provider Other Organization Name Type Code:
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:
1649775123
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 POWELL PL
Provider Second Line Business Mailing Address:
ATTN: LEGAL DEPARTMENT
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-7514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-732-1605
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
611 COMMERCE PKWY
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-727-8416
Provider Business Practice Location Address Fax Number:
615-457-8094
Provider Enumeration Date:
03/27/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
STOVALL
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
FACILITY CEO
Authorized Official Telephone Number:
662-281-9992

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X , with the licence number:  OOC-AGENCY , 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)