Healthcare Provider Details

I. General information

NPI: 1093348351
Provider Name (Legal Business Name): OXFORD ANESTHESIA GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2020
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

497 AZALEA DR STE 101
OXFORD MS
38655-7907
US

IV. Provider business mailing address

PO BOX 2045
MERIDIAN MS
39302-2045
US

V. Phone/Fax

Practice location:
  • Phone: 662-234-8904
  • Fax: 662-236-1191
Mailing address:
  • Phone: 601-282-7020
  • Fax: 601-974-3336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: LEA E WELBORN
Title or Position: OWNER
Credential: CRNA
Phone: 662-380-3514