MEDICARE: OXFORD MEDICAL GROUP, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center	G28196	CA

General Provider Information

NPI Number	:	1013968221
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OXFORD MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	4551 GLENCOE AVE
Second Line	:	SUITE 260
City	:	MARINA DEL REY
State	:	CA
Zip	:	90292-6385
Country	:	US
Telephone Number	:	310-301-2030
Fax Number	:	310-306-5247

Provider Business Practice Location Address
First Line	:	2400 S FLOWER ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90007-2629
Country	:	US
Telephone Number	:	213-742-1013
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	BARRY B. STAUM
Credential	:	M.D.
Telephone Number	:	310-301-2030

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	09/26/2007

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