Healthcare Provider Details

I. General information

NPI: 1831413772
Provider Name (Legal Business Name): OXFORD UROCARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2010
Last Update Date: 03/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 MEDICAL PARK DR STE 101
OXFORD MS
38655-5327
US

IV. Provider business mailing address

PO BOX 1013
OXFORD MS
38655-1013
US

V. Phone/Fax

Practice location:
  • Phone: 662-234-3448
  • Fax: 662-234-1490
Mailing address:
  • Phone: 662-234-3448
  • Fax: 662-234-1490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WANDA L SOCKWELL
Title or Position: OFFICE MANAGER
Credential:
Phone: 662-234-3448