Healthcare Provider Details

I. General information

NPI: 1174202097
Provider Name (Legal Business Name): OVERSIGHTMD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 MCCARTHY BLVD STE 1000
MILPITAS CA
95035-7451
US

IV. Provider business mailing address

1525 MCCARTHY BLVD STE 1000
MILPITAS CA
95035-7451
US

V. Phone/Fax

Practice location:
  • Phone: 408-509-2500
  • Fax:
Mailing address:
  • Phone: 408-509-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. MARK GODWIN
Title or Position: CEO
Credential:
Phone: 408-509-2500