Healthcare Provider Details

I. General information

NPI: 1588693972
Provider Name (Legal Business Name): THE PET CENTER OF OXFORD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1612 US HIGHWAY 78 W SUITE 102
OXFORD AL
36203-4014
US

IV. Provider business mailing address

1612 HWY 78 E SUITE 102
OXFORD AL
36203
US

V. Phone/Fax

Practice location:
  • Phone: 256-832-3550
  • Fax:
Mailing address:
  • Phone: 256-832-3550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number001535
License Number StateAL

VIII. Authorized Official

Name: ROBERT EICHELBERGER
Title or Position: RADIOLOGIST
Credential: M.D.
Phone: 256-832-3550