Healthcare Provider Details

I. General information

NPI: 1174904239
Provider Name (Legal Business Name): OXFORD VEIN CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 06/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 ENTERPRISE DR SUITE B
OXFORD MS
38655-2762
US

IV. Provider business mailing address

300 ENTERPRISE DR SUITE B
OXFORD MS
38655-2762
US

V. Phone/Fax

Practice location:
  • Phone: 662-638-3677
  • Fax: 662-638-3678
Mailing address:
  • Phone: 662-638-3677
  • Fax: 662-638-3678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number20317
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number20317
License Number StateMS

VIII. Authorized Official

Name: CHRISTINE WALDROP
Title or Position: OWNER
Credential: MD
Phone: 662-638-3677