1013723592 NPI number — OXFORD MAXILLOFACIAL SURGERY, INC.

Table of content: (NPI 1013723592)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013723592 NPI number — OXFORD MAXILLOFACIAL SURGERY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OXFORD MAXILLOFACIAL SURGERY, 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:
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:
1013723592
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2886 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:
38655-5347
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-236-7888
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
218 S THOMAS ST STE 122
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUPELO
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38801-5300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-690-5354
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/09/2024

Additional Information

Authorized Official

Authorized Official Last Name:
CARIDE
Authorized Official First Name:
NICOLE
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING
Authorized Official Telephone Number:
727-784-2721

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com