MEDICARE: OASIS CLINICAL CARE MANAGER, 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	1041C0700X	Clinical Social Worker	C005215	NC
2	1041C0700X	Clinical Social Worker	C006053	NC
3	1041C0700X	Clinical Social Worker	C005319	NC
4	1041C0700X	Clinical Social Worker	P002725	NC
5	103TC0700X	Clinical Psychologist	3676	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
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619105988
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OASIS CLINICAL CARE MANAGER, LLC

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

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

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. THEODUS ROACH
Credential	:
Telephone Number	:	704-604-1437

Provider Enumeration Date	:	06/25/2009
Last Update Date	:	06/25/2009

Similar Medicare Providers

1174594980 — DR. JOSEPH DAVID SPATARO MD
Practice Location Address:

6101 IDLEWILD RD , SUITE 300
CHARLOTTE, NC
28212-0517

Practice Phone: 704-531-0990
Practice Fax: 704-531-0464

1356427082 — ACCESSHOME HEALTHCARE INC
Practice Location Address:

6101 IDLEWILD RD , 324
CHARLOTTE, NC
28212-0517

Practice Phone: 980-219-7468
Practice Fax: 980-219-7469

1568512317 — ALL ABOUT FAMILY INC.
Practice Location Address:

6101 IDLEWILD RD , SUITE 100
CHARLOTTE, NC
28212-0517

Practice Phone: 704-535-1526
Practice Fax:

1932398294 — JOSEPH D SPATARO MD PC
Practice Location Address:

6101 IDLEWILD RD , SUITE 300
CHARLOTTE, NC
28212-0517

Practice Phone: 704-531-0990
Practice Fax: 704-531-0464

1598907123 — OASIS CLINICAL CARE MANAGEMENT, LLC
Practice Location Address:

6101 IDLEWILD RD , SUITE 127
CHARLOTTE, NC
28212-0517

Practice Phone: 704-536-8381
Practice Fax: 704-536-8383

1881826873 — DR. HERBERT LEE FERRELL D.C.
Practice Location Address:

6101 IDLEWILD RD , SUITE 328
CHARLOTTE, NC
28212-0517

Practice Phone: 704-295-1399
Practice Fax:

Directions to “OASIS CLINICAL CARE MANAGER, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.