Healthcare Provider Details

I. General information

NPI: 1538214143
Provider Name (Legal Business Name): OXFORD PHYSICAL MEDICINE & REHABILITATION PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 01/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 N LAMAR BLVD
OXFORD MS
38655-3242
US

IV. Provider business mailing address

705 N LAMAR BLVD
OXFORD MS
38655-3242
US

V. Phone/Fax

Practice location:
  • Phone: 662-236-7070
  • Fax: 662-236-7078
Mailing address:
  • Phone: 662-236-7070
  • Fax: 662-236-7078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN R TAIT
Title or Position: SOLE MEMBER
Credential: M.D.
Phone: 662-236-7070