Healthcare Provider Details

I. General information

NPI: 1831482496
Provider Name (Legal Business Name): OXFORD DIALYSIS ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2011
Last Update Date: 05/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 ACCESS RD SUITE 300
OXFORD MS
38655-5209
US

IV. Provider business mailing address

1300 ACCESS RD SUITE 300
OXFORD MS
38655-5209
US

V. Phone/Fax

Practice location:
  • Phone: 662-232-8005
  • Fax:
Mailing address:
  • Phone: 662-232-8005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number13545
License Number StateMS

VIII. Authorized Official

Name: DR. JON H MASSEY
Title or Position: PRESIDENT
Credential: MD
Phone: 662-232-8005