MEDICARE: OAKTREE MEDICAL CENTRE, PC

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	261QP3300X	Pain Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134106693
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAKTREE MEDICAL CENTRE, PC

Provider Business Mailing Address
First Line	:	PO BOX 484
Second Line	:
City	:	EASLEY
State	:	SC
Zip	:	29641-0484
Country	:	US
Telephone Number	:	864-855-1633
Fax Number	:	864-855-1323

Provider Business Practice Location Address
First Line	:	200 PATEWOOD DR
Second Line	:	SUITE A 350
City	:	GREENVILLE
State	:	SC
Zip	:	29615-3593
Country	:	US
Telephone Number	:	864-242-6447
Fax Number	:	864-242-6517

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DANIEL A. MCCOLLUM
Credential	:	D.C.
Telephone Number	:	864-855-1633

Provider Enumeration Date	:	12/27/2005
Last Update Date	:	10/30/2007

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