MEDICARE: OASIS CLINICAL CARE MANAGEMENT, LLC

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	251S00000X	Community/Behavioral Health Agency	6005982	NC

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598907123
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OASIS CLINICAL CARE MANAGEMENT, LLC

Provider Business Mailing Address
First Line	:	1501 N CHARLOTTE AVE
Second Line	:
City	:	MONROE
State	:	NC
Zip	:	28110-2525
Country	:	US
Telephone Number	:	704-536-8381
Fax Number	:	704-536-8383

Provider Business Practice Location Address
First Line	:	6101 IDLEWILD RD
Second Line	:	SUITE 127
City	:	CHARLOTTE
State	:	NC
Zip	:	28212-0517
Country	:	US
Telephone Number	:	704-536-8381
Fax Number	:	704-536-8383

Authorized Official
Title or Position	:	ADMIN
Name	:	MRS. LILLIAN ROACH
Credential	:
Telephone Number	:	704-536-8381

Provider Enumeration Date	:	03/27/2009
Last Update Date	:	03/27/2009

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