Healthcare Provider Details

I. General information

NPI: 1649775123
Provider Name (Legal Business Name): OXFORD OUTPATIENT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 COMMERCE PKWY
OXFORD MS
38655
US

IV. Provider business mailing address

500 WILSON PIKE CIR STE 360
BRENTWOOD TN
37027-3266
US

V. Phone/Fax

Practice location:
  • Phone: 615-727-8416
  • Fax: 615-457-8094
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberOOC-AGENCY
License Number StateMS

VIII. Authorized Official

Name: MS. KEISHA WYNN
Title or Position: DIRECTOR OF OUTPATIENT OPERATIONS
Credential: MSN, RN
Phone: 828-215-1455