1508914102 NPI number — OXFORD LUNG PHYSICIANS, P.A.

Table of content: (NPI 1508914102)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508914102 NPI number — OXFORD LUNG PHYSICIANS, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OXFORD LUNG PHYSICIANS, 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:
1508914102
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/05/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 768
Provider Second Line Business Mailing Address:
2301 S LAMAR BLVD. STE 100
Provider Business Mailing Address City Name:
OXFORD
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38655-0768
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-234-0119
Provider Business Mailing Address Fax Number:
662-234-0090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2301 S LAMAR BLVD STE 100
Provider Second Line Business Practice Location Address:
2301 S LAMAR BLVD STE 100
Provider Business Practice Location Address City Name:
OXFORD
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38655-5373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-234-0119
Provider Business Practice Location Address Fax Number:
662-234-0090
Provider Enumeration Date:
01/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
EVANS
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
N
Authorized Official Title or Position:
PRESIDENT OWNER
Authorized Official Telephone Number:
662-234-0119

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  12109,17162,R862053 , 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: 07906092 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00115527 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00239013 . This is a "MCR UNITED HEALTHCARE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 05132705 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00143146 . This is a "MCR UNITED HEALTHCARE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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