Healthcare Provider Details

I. General information

NPI: 1821273491
Provider Name (Legal Business Name): OXFORD PHYSICAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 01/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 N LAMAR BLVD
OXFORD MS
38655-3242
US

IV. Provider business mailing address

PO BOX 2395
OXFORD MS
38655-7000
US

V. Phone/Fax

Practice location:
  • Phone: 601-366-9261
  • Fax:
Mailing address:
  • Phone: 601-366-9261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: RON MILONE
Title or Position: BILLING
Credential:
Phone: 601-366-9261