Healthcare Provider Details

I. General information

NPI: 1699942854
Provider Name (Legal Business Name): OASIS MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2008
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W DUCK LAKE DR
BOISE ID
83714-1834
US

IV. Provider business mailing address

3217 W BAVARIA ST
EAGLE ID
83616
US

V. Phone/Fax

Practice location:
  • Phone: 208-286-6676
  • Fax: 208-672-8385
Mailing address:
  • Phone: 208-286-6676
  • Fax: 208-672-8385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JESSE MCMULLIN
Title or Position: ADMINISTRATOR
Credential: RT, DS
Phone: 208-286-6676