1477817526 NPI number — OXFORD CENTRE PHYSICIAN GROUP, P.A.

Table of content: (NPI 1477817526)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477817526 NPI number — OXFORD CENTRE PHYSICIAN GROUP, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OXFORD CENTRE PHYSICIAN GROUP, P.A.
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:
1477817526
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3488
Provider Second Line Business Mailing Address:
DEPT. 05-022
Provider Business Mailing Address City Name:
TUPELO
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38803-3488
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-281-9992
Provider Business Mailing Address Fax Number:
662-281-1326

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1916 UNIVERSITY AVE
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:
38655-4114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-281-9992
Provider Business Practice Location Address Fax Number:
662-281-1326
Provider Enumeration Date:
07/03/2012

Additional Information

Authorized Official

Authorized Official Last Name:
FOWLKES
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
DEBOW
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
662-281-9992

Provider Taxonomy Codes

  • Taxonomy code: 103TP2701X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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